natgen premier supplemental application
TRANSCRIPT
NatGen Premier Supplemental Application
Homeowner Eligibility Questions 1. Does the applicant conduct a home-based business on the premises?2. Has applicant had a foreclosure, repossession judgment, lien, bankruptcy during the past five years?3. Has prior insurance been cancelled, declined or non-renewed in the past five years for reasons other
than agency termination, carrier insolvency or a carrier decision to eliminate exposure in a state?4. Does the applicant or any tenant own a dog or animal of the breeds listed?5. Has any applicant been convicted of any degree of the crimes of arson or fraud?6. Is the dwelling built on pilings, piers, wharves, jetties or is the dwelling foundation open?7.8.9.10.11.12.
Does the dwelling have an electrical system with knob and tube or aluminum wiring?Is the premises used for farming (other than incidental)?Is the house for sale by the applicant?Is the condominium a timeshare or rented more than 3 months per year?Is there a trampoline or a skateboard ramp on the premises?Is there any existing damage present on the dwelling to be insured?
Auto Eligibility Questions 1. Is any vehicle a hearse, limousine, postal model, H1 Hummer, GEM or had its performance modified
by a kit or package such as Callaway C-12, Dinan, Hammer, Lingfelter, Mallet, Ruf, Saleen or Stillen?2. Are any vehicles equipped with altered suspensions such as street rods, cooking equipment or
bathrooms or snow plows used for commercial snowplowing?3.
4. Is any vehicle regularly available to non-listed drivers other than resident relatives?5. Does the applicant have proof of prior insurance?
Umbrella Eligibility Questions 1. Does the applicant have any primary underlying auto and/or home policies written with another
insurance company?2. Is there a swimming pool with a diving board more than 18 inches above the water surface or
without locked access at any premises?3. Is there a trampoline, tree house or skateboard ramp at any premises?4. Does the applicant or any tenant own a dog or animal of the breeds listed?5. Are there any properties with Home Day Care?
Yes
Yes
Yes
Yes
YesYes
Yes
YesYesYes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
No
No
No
No
No
No
NoNoNo
No
No
No
No
No
No
No
No
No
Are there any vehicles used for racing, retail, or wholesale pickup or delivery of Goods, limousine ortaxi services, livery or emergency services?
2/3/2020 1 of 2
6. Are there any properties with Dwelling Under Construction or having significant renovation?7. Has any prior auto, property, watercraft or umbrella policy been declined, cancelled or
non-renewed in the past five years?8. Have you had any prior Umbrella claims?9. Any aircraft owned, leased, chartered or furnished for regular use?10. Does any driver have physical/mental impairments?11. Any real estate, vehicles, watercraft, aircraft used commercially or for business purposes?12. Any real estate, vehicles, watercraft, aircraft owned, hired, leased or regularly used not
covered by primary policies?13. Does the applicant engage in any type of farming operation (other than incidental) at any
owned property?14. Do you hold any non-compensated positions?
Does the applicant employ any full time residence employees or domestic workers?Any non-owned property exceeding $1000 in value, in your care, custody or control?Any pending litigation, court proceedings, or judgments?Are there any recreational vehicles, such as a dune buggy, golf cart, snowmobile, motorcycle, moped, motor home, or personal watercraft (jet-ski, jet boat, etc.)Are there any operators excluded under any auto policy, watercraft or recreational vehicle policy?Are there more than 2 horses or farm animals of any type at any premises?
Yes
Yes
Yes
Yes
YesYes
Yes
Yes
Yes
No
No
NoNoNo
No
No
No
No15.16.17.18.
19.
YesYesYes
YesYes
NoNoNo
NoNo
20. Yes No
2/3/2020 2 of 2