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Applicant_First_Name: Bob
Applicant_Middle_Initial: W
Applicant_Last_Name: Smith
Applicant_Mailing_Address: 555 NW 45th Street - Apt. H25
City: Hialeah
Zip_Code: 33012
Applicant_Email_Address: bobs@yahoo55.com
Applicant_Home_Phone: 305-555-5555
Applicant_Work_Phone: 305-555-4444
Extension_Number: 55
Contact_Me: Phone at Home
Applicant_Cell_Phone: 305-555-7777
Birth_Date: 5/21/1965
Social_Security_Number: 451-68-9525
Currently_Insured?: Yes
Current_Yearly_Premium: $185
Coverage_Requested_For: Apartment
Years_Lived_at_Address_to_be_Insured: 2-5 years
Personal_Property_$_Value: 15,000
Personal_Liability_(each_occurence): $100,000
Medical_Payments_(each_person): $1,000
Deductible: $250
Actual_Cash_Value,_Contents: No
Replacement_Cost,_Contents: Yes
Contact Information
Property Information
Building_Structure: Brick Veneer
#_of_Stories_High: 3
#_of_Units_in_Building: 12
Year_Dwelling_Built: 1994
Dwelling_Square_Feet: 850
Smoke_Detectors?: Yes
Deadbolt_Locks?: Yes
Central_Burglar_Alarm?: No
Central_Fire_Alarm?: No
Sprinklered_All_Rooms?: Yes
Garage: none
Dwelling_Location: Within City Limits
Any_losses_last_5_years?: No
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