Landlord | Witkin Insurance

top of page

Witkin Insurance

(323) 457-5294

Home
Personal
Commercial

Landlord Insurance Policy
Application

Please complete the form so we can help you secure the coverage you need

Applicant Information

First name*

Last name*

Email*

Phone*

Desired Effective Date of Coverage*

Named Insured

Primary Named Insured*

Address*

Phone*

What is the Business Structure*

Are there other named insureds?*

Yes

No

Contact Information

Primary Contact is same as applicant

Contact Name*

Phone*

Email*

Additional Interest

Are there any Additional Interests?*

Yes

No

Are there other Additional Interests?*

Yes

No

Business Details

Date business started (approximate)*

Month

Day

Year

Property's Average Monthly Revenue*

Has coverage been declined, cancelled, or non-renewed in the past 3 years?*

Yes

No

Has this property had any losses in the past 5 years?*

Yes

No

Loss Runs for the Past 3-5 years

If the business has been placed in a trust, what is the trust's name?

Proof of coverage for the Past 3 years

Premises Information

Address to be insured*

Building Details

Current Wiring Material*

Has the Wiring Been Updated?*

Completely

Partially

No

The Property to be insured does not use an electrical system with known high failure rates such as: Challenger, Federal Pacific Stab-Lok, Pushmatic breakers manufactured by ITE, Siemens, or Bulldog, (some) Sylvania GTE products, Zinsco, including Zinsco compatible breakers such as Kearney nor does it use Fuses

Current Plumbing Material*

Has the Plumbing Been Updated?*

Completely

Partially

No

Has the Roof Been Updated?*

Completely

Partially

No

Has the HVAC Been Updated?*

Completely

Partially

No

% of Vacant Units*

Copy of Existing Policy

Are there multiple buildings?*

Yes

No

Privacy Policy

LIC# 4416083

bottom of page

(323) 457-5294

Landlord Insurance Policy Application

Landlord Insurance Policy
Application