Flood Insurance Application Data Sheet

City:     State:     ZIP:
Is insured property location same as insured's address: Yes    No
When do you want coverage to be in effect: (mm/dd/yy)
Construction, Placement, or Substantial Improvement Date of property to be insured: (mm/dd/yy)

Building occupancy/residential:    single family    2-4 family    other residential    non-residential (including hotel/motel)

Number of floors in entire building (include basement or enclosed area, if any), or building type:
1 floor    2 floors    3 or more    split level    townhouse/rowhouse (RCBAP lowrise only)   
manufactured (mobile) home on foundation)

Is the building elevated?    Yes    No        If yes, area below is:    free of obstruction   with obstruction

Building Diagram:
1 or more floors, slab on grade construction
1 or more floors basement/crawl space below grade on all sides
Split level, slab on grade construction
Split level base or crawl space below grade on all sides
Elevated, piers/posts/parallel shear walls, no enclosure below
Elevated, full story foundation walls, full or partial enclosure
Elevated, over crawl space at, above, or below grade on at least 1 side

If Condo, Coverage is for:     Unit         Entire Building
Residential Condominium Building Association Policy Only. Total number of units (include non-res): high-rise    low-rise

Estimated replacement cost if RCBAP, or a building located in an area with additional hazards associated with storm waves (Zone V): (amount)

Contents Location:
basement/enclosure only    lowest floor above ground level and higher    basement/enclosure and above
above ground level more than one full floor    lowest floor only above ground level    manufactured (mobile) home
(Note: If single family, contents are rated throughout the building.)

Is building flood-proofed?    Yes    No