Add a new property

Hazard & liability insurance program

Use this form to add a new property to the portfolio under the bulk billing arrangement for .

Hi ,

Welcome back. Please complete the form below and click the submit button to add a property to your bulk billing arrangement.

You can use this page to add as many properties as you need to, all at the same time, by clicking the “Add another property” button.

BI Additional Property (Bulk Billing)

New Properties

Street *

City *

State *

ZIP *

Type of Cover *

Start Date *

Property Type *

Residential is 4 or less units

Sum Insured *

No of Units *

Sq Feet *

Year Built *

Year roof replaced *

select the approximate year the roof was replaced

Electrical Sys *

Breakers

Fuses

Occupancy *

Occupied

Vacant

Construction *

Owner Name

Owner Email Address

Additional Insured

Add another property Remove this property

By submitting this application, I agree to be bound by the terms and conditions of Stateside APM and its insurance carriers. I agree that I will pay the additional subscription and setup costs, and cost of insuring this property from the date shown and understand it will be added to my next invoice .

This property will be added to Stateside APM’s master policy and billed to the portfolio under the bulk billing arrangement for

“Vacant Land” can only be selected if there is no building on the property. I understand that only liability cover will be provided. The admin fee for this type of cover is $30 per month.

I further agree that it is solely my responsibility as the property manager of this property to ensure that the owner is fully aware of the policy terms and conditions and that I have provided the owner with instructions how to view them. I further agree to hold harmless Stateside APM in the event that I fail to do so.

Full details of the policy terms and conditions and claims procedures, together with any additional terms and conditions imposed by Stateside APM are available at portal.statesideapm.com/iptc

Submitted by *

On Behalf of Company

Date

Confirmation will be sent to this email address *

Confirm Confirmation will be sent to this email address *

If you are human, leave this field blank.