Private Client Group University (PCG-U)

Homeowners Quote Request

Multinational accounts

Applicant information

Name:
Nationality: / Date of birth:
Employer: / Occupation/position:
Correspondence address:
Contact phone number:
Email address:

AIG is the marketing name for the worldwide property-casualty, life and retirement, and general insurance operations of American International Group, Inc. AIG Private Client Group is a division of the member companies of American International Group, Inc. For additional information, please visit our website at www.aig.com. All products and services are written or provided by subsidiaries or affiliates of American International Group, Inc. Products or services may not be available in all countries, and coverage is subject to actual policy language. Non-insurance products and services may be provided by independent third parties. Certain property-casualty coverages may be provided by a surplus lines insurer. Surplus lines insurers do not generally participate in state guaranty funds, and insureds are therefore not protected by such funds.

PCG_647 REV032516

Client acknowledges that communications and policy documentation will be provided in English wherever possible but the version in the local language will prevail in the event of any discrepancy. Please sign or check box if you would like a copy of the local policy in the local language:

Property details/protections

Property address:

Type of property: / Detached house / Semi-detached house / Terraced house / Flat/apartment
Residence: / Main residence / Holiday home / Rented to others
Construction Type / Masonry / Frame / Reinforced Concrete / Masonry Veneer
Type of occupancy: / Owner-occupied / Seasonal/secondary / Unoccupied/vacant / Tenant
Roof Type: / Asphalt Shingle / Slate / Rubber Membrane / Other
Roof Shape: / Gable / Hip / Flat / Other
Roof Age:
Burglar alarm: / Central station / Local only / None / Other:
Security protection: / 24-hour guard / Gated/fenced / Surveillance cameras
Fire alarm: / Central station / Local smoke only / Fire extinguishers / None
Fire protection: / Fire hydrant within 1,000’ / Fire station within 5 miles
Caretaker/domestic employee: / Full-time lives on premises / Full-time lives off premises / Part-time / None
Basement: / Yes / No
Sprinkler System: / Yes / No

Number of domestic staff: What type of work do they do?

Year built: Renovated year:

Gross floor area (sq. ft.): Number of Stories:

Does the home have a basement?

Yes / No

If you have a renovation planned in the next 12 months, please specify:

For properties within 10 miles of coastal water:

What is the distance to shore?

What is the elevation above sea level?

Confirm if location has shutters or hurricane impact glass, doors and garage doors protected?

For properties requesting Earthquake:

Has the home been retrofitted?

Yes / No

Is the frame bolted to the foundation?

Yes / No

Are there sheer walls present?

Yes / No

Is the foundation engineered to resist earthquake?

Yes / No

Homeowners coverage

(Please indicate requested limits in US$)

Excess/deductible / Sum insured
Building (please indicate rebuilding cost)
Other permanent structures (please indicate rebuilding cost)
Contents (please indicate replacement cost)
Personal liability

Loss history

Have you made any insurance claims in the past five years? (all lines of business) / Yes / No
Have you ever been declined similar overage by an insurance company in the last five years? / Yes / No
If yes to either of the above, please provide details:

Broker information

Name/company:
Office phone number: / Mobile number:
Fax number: / Email address:

(Updated 9.16.16)

PCG_647 REV032516