A home insurance questionnaire is the process of assessing the sum assured and the premium to be paid for the insurance of a home or any kind of residential property. This questionnaire is helpful for the company providing home insurance and is filled up by the individual who wants to get his home insured. This questionnaire gives idea about the security measures in the house and the date in which the house was built or purchased by the owner.

Sample Home Insurance Questionnaire

Name: First name: _______ Middle name: __________ Surname: _________

Address: Street address __________ City name ________ State name _________

Postal code _________

Address of residential property to be insured (if different from above): Street address __________ City name ________ State name _________ Postal code _________

Residential Contact number: _____________ Mobile number: ________

Email id: _________________

1. What kind of residential property do you own?

a) Mansion

b) Row house

c) Apartment

d) Duplex

2. How many years has it been since you purchased your home?

a) Less than one year

b) Less than three years

c) Less than five years

d) More than five years

3. Was your home built in the same year, you purchased it?

a) Yes

b) No

4. If the answer to the above question is no, when was you home built?


5. Do you have any of the following security measures in your home?

a) Fire extinguisher

b) Smoke indicator

c) Security alarm

d) Security cameras

6. When did you renovate your home last time?