Section 13, Part B - Homeowners' Insurance - Detailed Questions
Section 13, Part B collects detailed information about homeowners' insurance policies reported in Part A.1.
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What is the name of the insurance company for "your (1st, 2nd, 3rd)"
homeowners' policy listed? [enter text] ____________________
Briefly describe the policy. [enter text] ______________
Which property(ies) does/did this policy cover?
[enter text] ____________________
Are the policy premiums paid -
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?
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 Homeowners' Insurance
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Last Modified Date: April 12, 2011