Section 13, Part B - Renters' Insurance - Detailed Questions

Section 13, Part B collects detailed information on renters' insurance policies reported in Part A.1.

For definitions Information Booklet »

What is the name of the insurance company for "your (1st, 2nd, 3rd)" renters' policy listed? [enter text] ____________________
* Enter name of insurance company, not the insurance agent.

Briefly describe the policy. [enter text] ______________

Are the policy premiums paid -

1. Entirely by you or your household?
2. Partially by you or your household and partially by someone outside your household?
3. Entirely by an employer or union?
4. Entirely by another group or persons outside your household?

Are any premiums paid through payroll deductions?

1. Yes
2. No

Since the first of the reference month, what was your or your household total expense for this insurance policy? [enter value] ______________

* Enter the actual amount the household paid. Do not include any expenses paid for the household by others

How much was paid this month? [enter value] ______________

End of Section 13B Renters' Insurance

Go to Section 13 Part B - Vehicle Insurance »

Go to Section 14 Part A.1 - Hospitalization and Health Insurance »

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Last Modified Date: April 5, 2010