INSTRUCTIONS FOR COMPLETING 
BROAD FORM E - DWELLING APPLICATION

NYPIUA OFFERS THE FOLLOWING COVERAGES/CAUSES OF LOSS:
  • Fire Insurance, Lightning and Explosion
  • Extended Coverage - Windstorm, Hail, Riot, Riot attending a strike, Civil Commotion, Damage due to Aircraft, Damage due to vehicles, and Smoke  
  • Vandalism & Malicious Mischief (Not available for vacant or unoccupied buildings)
  • Broad Form Perils - Property damage by burglars (not theft of property), falling objects, weight of ice, snow or sleet, accidental discharge of water or steam, sudden cracking of a steam or hot water heating system, freezing, sudden damage from artificial electrical currents.
  • Additional Living Expense
  • Rental Value
REMEMBER:
  • BOTH Producer and Insured must sign the e-dwelling application.
  • Enter proper deposit using a checking account.
  • Answer all questions completely.
  • Give complete description of property and address.
DEPOSIT SCHEDULE:
Determine the deposit premium as per the following schedule:
Personal Property .............$50.00 
1-4 Family Private Dwellings ......$75.00 for each $50,000 of coverage or any fraction thereof.
No additional deposit is required for Extended Coverage, Vandalism & Malicious Mischief, Broad Form Perils, Additional Living Expense, or Rental Value.
Calculate deposits separately for building and Personal Property. 
( Click here to Calculate Deposit Amount)

(THE PREMIUM ACCEPTED WITH THIS APPLICATION IS FOR DEPOSIT PURPOSES ONLY. ACCEPTANCE OF A DEPOSIT IS NOT AN AGREEMENT TO INSURE.  IF COVERAGE IS DECLINED, THE DEPOSIT WILL BE RETURNED.)

BINDING DATES:

  • 12:01 AM standard time, on the day after receipt, unless a later date is specified.
  • 12:01 AM standard time, 17  days after receipt on risks previously cancelled by the Association.
The following buildings are not eligible for broad form coverage:
  • Vacant or Unoccupied Buildings.
  • Substantially Vacant Buildings.
  • Buildings described as in the course of Repair or Reconstruction.
  • Buildings in the Course of Construction.
  • Buildings or contents therein which have been subject to two (2) or more Broad Form Peril Losses within a three (3) year period when such losses are due to conditions which are within the control of the applicant.
  • Building with deteriorated plumbing systems.
  • Mobile Homes.

 

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