Homeowners Insurance Questionnaire

The homeowner’s insurance questionnaire has to be filled by an applicant who is basically applying for homeowner insurance. Homeowner insurance is also known as home insurance and it combines various types of personal insurance protections and covers losses inside a home or private property as well as accidents within the home.

Sample Homeowners Insurance Questionnaire:

Name of the Applicant/Insured: _________________

Address: _____________________________ State: ________  Zip: _________

Phone Number: ______________

Email Address: ______________

Social Security #: ______________________________

Number of Rooms in the house:________  Year built: ________

Number of years in this house: __________ (years) __________ (months)

Q1.  How many rooms are there in your home?

  • 1 room
  • 2 rooms
  • 3-5 rooms
  • More than 5 rooms

Q2.  How many members reside in your home?

  • Single member
  • 1-3 members
  • 3-5 members
  • 5-7 members
  • More than 7 members

Q3.  What is the total square feet of living area?


Q4.  Does your home have a basement?

  • Yes
  • No

Q5.  Which of the following renovations have you made in the last 1 year?

  • Electrical
  • Plumbing
  • Heating
  • Décor

Q6.  Which of the following security systems have you enabled in your home?

  • Deadbolts
  • Fire extinguisher / hydrant
  • Fire Alarm
  • Smoke alarm
  • Burglar alarm
  • Security cameras
  • Motion detectors
  • Wireless security systems
  • Sprinkler system

Q7.  Which of the following have you used in exterior walls?

  • Brick
  • Wood
  • Veneer
  • Stucco on frame
  • Masonry

Q8.  Which of the following personal possession do you keep in the house?

  • Jewelry
  • Paintings
  • Electronics
  • Oriental Rugs
  • Computers
  • Firearms
  • Watercraft
  • Business documents
  • Inflammable items
  • Rare artifacts
  • Others

Q9.  What is the amount of content coverage that you require?


Q10.  What is the amount of liability coverage that you require?


Category: Insurance Questionnaire

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