100 Wall Street, 25th Floor
New York, NY 10005-3701

  

Tel: (212) 797-9600
Toll Free: (800) 962-5524
Fax: (212) 425-0719
Building Information Worksheet
Today's Date:
Your Name:
E-mail Address:
Building Name:
Address:
Apt. #:
City:
State:
Zip Code:
Construction: Brick  Frame
Number of stories:
Block Number:
Lot Number:
Number of Apartments (Including Super):
Square footage of Building:
Check the ones you have:
Smoke Detectors Window Guards
Exit Signs Fire Extinguishers
Elevator Emergency Lighting
Intercom/Buzzer System

Number of Commercial Stores (If any):
What kind of store?:
HDFC Office: yes no
Contents of Office:
Year:
of Renovation: Painted:
Electrical: Plumbing:
Roof:

Current Insurance Carrier:
Expiration Date: --
Limits:  
Fire:
General Liability:
Premium(s):
Fire Losses: yesno
If yes, when was the fire?
Have repairs been made?: yes   no
How much was the loss?:
Reported General Liability Losses: yesno
Name of Lender/Loan (if any):
Address of Lender/Loan (if any):
Name of HDFC Representative:
Fax Number:
 
Building Manager:
Telephone Number:
Actual Purchased Date or Future Purchase Date: