Edison Insurance Application Information Edison Insurance Application Information Name (all owners):*Property Address*Email address*Mailing address*Phone number(s)*Do we have permission to text you at that phone number?* Yes No Date(s) of birth for all owners*Occupation(s) for all owners*Relationship of applicants (example: married, mother and son, etc)*Do we have your permission to run credit/loss history reports?* Yes No Prior address for the last 3 years*Number of amps for electrical system*Plumbing type (copper, PEX, PVC, full or partial galvanized, full or partial polybutelene etc)*In addition to the First Named Insured and Co-Applicant (if applicable), do other individuals occupy the dwelling? If yes, please provide names, dates of birth and relationship to insured:*At the time of purchase and/or building this home, were there any disclosures on the residence and/or property to be insured concerning sinkhole activity and/or cracking, movement, raveling, listing, leaning or buckling of a foundation, floor or wall?* Yes No Does the residence and/or property to be insured under this policy have any known or suspected sinkhole or sinkhole activity, or has it experienced any cracking, movement, raveling, listing, leaning or buckling of a foundation, floor or wall, whether repaired or not?* Yes No Has the applicant(s) ever requested a sinkhole investigation, ground study, and/or sinkhole inspection for any reason other than an inspection to request sinkhole insurance coverage for the house and/or property to be insured?* Yes No Has the applicant(s) and/or additional insureds ever submitted a claim for sinkhole damage/loss on the residence and/or property to be insured?* Yes No Has the applicant(s) ever been convicted of a felony or insurance fraud?* Yes No Will the applicant(s) be living at and occupying the home within 30 days of the effective date of the application?* Yes No Are the applicant(s) and all additional insureds, if applicable, listed on the deed?* Yes No Is there any existing damage on the home, or is the home under construction, renovation, or repairs?* Yes No Is there a child or adult daycare, assisted living care or any rehabilitation activities on the property?* Yes No Is any business conducted on the property?* Yes No Do any of the following exist on the property: Trampoline, Skateboard Ramp, Empty Swimming Pool, Bicycle Ramp, Diving Board?* Yes No Do you have any pets? If yes, list the type, breed and whether the pet has ever attacked anyone:*Does the property have a pool? If yes, is the pool fenced or screened?*Any losses other than lightning, tornado, hail or hurricane whether or not paid by insurance during the last 3 years at this or any other location? If yes, list the date of loss, type of loss, amount paid and whether the damage is repaired:*Mortgage company name, phone number and loan number:*Does your mortgage company escrow?* Yes No Purchase date*Purchase price*
