Florida Homeowner Insurance Application | Hendrickson Insurance, Sarasota FL

A. Applicant Information

First Named Insured (full name) *

Required.

Date of birth

Co-applicant / spouse (full name)

Co-applicant date of birth

Primary phone *

Required.

Email address *

Enter a valid email.

Occupation

Co-applicant occupation

Current / prior home address (street, city, state, ZIP)

Years at address

Marital status

Single Married Divorced Widowed

B. Property / Risk Location

Property street address *

Required.

City

State

ZIP

County

Mailing address (if different)

Occupancy type

Primary residence Secondary / Seasonal Rental / Tenant-occupied Vacant / Under renovation

Purchase date

Purchase price

Requested effective date

Est. replacement cost

C. Dwelling & Construction

Year built

Living area (sq ft)

# stories

# bedrooms

# bathrooms

Foundation

Slab Crawlspace Basement Piers / Stilts

Roof shape

Hip Gable Flat Other

Year roof last replaced

Garage type (attached / detached / none)

# cars

Present features

D. Systems & Recent Updates

Enter the year each system was last updated, or "Original" if it has never been replaced.

Roof (year)

Electrical (year)

Plumbing (year)

HVAC / heating (year)

Water heater (year)

Electrical service (amps)

Panel type (breaker / fuse)

E. Protective Devices & Safety

Distance to nearest fire hydrant

Distance to fire station (miles)

F. Wind / Hurricane Mitigation (Florida)

This section is optional, but every answer helps us sharpen your Florida pricing — wind mitigation credits are often the largest discount on a coastal home.

Secondary water resistance (SWR)

Yes No Unknown

G. Coverage Requested

A – Dwelling

B – Other structures

C – Personal property

D – Loss of use

E – Personal liability

F – Medical payments

All-peril deductible

Hurricane / wind deductible

Optional coverages

H. Additional Exposures

Dog breed(s) and number

I. Prior Insurance & Loss History

Current / most recent carrier

Policy expiration date

Years continuously insured

If any loss / claim, list date, type, and amount

J. Acknowledgement

I certify that the information above is true and complete to the best of my knowledge. Submitting this form does not bind coverage; coverage is subject to underwriting approval and payment of premium.

Typed signature (full name) *

Required.

Date *

Required.

I agree to the statement above. *

Please confirm to submit.

Homeowner application.

A. Applicant Information

B. Property / Risk Location

C. Dwelling & Construction

D. Systems & Recent Updates

E. Protective Devices & Safety

F. Wind / Hurricane Mitigation (Florida)

G. Coverage Requested

H. Additional Exposures

I. Prior Insurance & Loss History

J. Acknowledgement

Thank you — application received

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