HOME REPLACEMENT EVALUATION FORM
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Insured Name
:
Policy
#
Insured Location
:
Year built
:
(Updating if over 20 years. Photo of front & rear required)
Roofing
:
yrs old
Heating
last serviced in:
Wiring
(
knob tube
circuit breaker
60 amp
100 amp)
Plumbing
(
copper
galvanized)
Construction
:
Wood frame
Fire-resistive
Commercial units in the building
Others (describe):
Style
:
Detached
Semi-detached
Duplex (
side by side
up & down)
Townhouse
Apartment (
over
under 6 units)
No of Stories
:
1
1.5
2
2.5
1+ basement
2+ basement
Bi-levels
Tri-levels
Others
Others (describe):
Floor area
(sq. ft.): Main:
Upper:
Down:
Finished Attic:
Basement
(sq. ft.): Finished:
Unfinished:
Separate entrance
Yes
No
Heating Fuel
:
Gas
Electric
Wood
Oil (oil tank age:
in ground
above ground)
Heating system
:
Forced air
Hot water radiant
Baseboard
Wood burning stove
# of Fireplace
: Wood Burning:
Gas:
Wood Stove:
% of Exterior Wall:
Stucco:
Wood:
Brick:
Vinyl:
Aluminum:
Stone:
Others (describe):
Roofing
Asphalt
Wood
Tar & Gravel
Clay Tile
Concrete Tile>
Others (describe):
Garage
:
Attached
detached
Carport
Build-in
Basement # of cars:
1
2
3
4
Outdoor Area
(sq. ft.):
Patio:
Balcony:
Deck:
Porch:
Sun Room:
Greenhouse:
Detached structures
:
Stable
Shed
Gazebo
Cabana
Swimming Pools
: Level
in ground
above ground
Material
fiberglass
Vinyl
Concrete
Area:
sq ft.
% of Flooring
:
Hardwood:
Carpet:
Laminate:
Ceramic Tile:
Vinyl:
Others:
# of Bathrooms
: 2 pcs:
3 pcs:
4 or more:
Other Features
:
Central Vacuum
Intercom
extra Kitchen
Skylights #
Hot Tub
Jacuzzi
Wet Bar
Central Air Conditioning
Sprinkler
Smoke Detector
Burglar Alarm
Fire Alarm (
Local
monitored by
)
Block Watch
Hydrant protect
Fire hall (
protected
unprotected
)
Choose your recipient Nakamun Office:
Newcombe
Alpine
Somerset
Murrick
Killarney