Home-Based Daycare Business Insurance Application
Applicant Information
Full Name
Date of Birth
Home Address
Phone Number
Email Address
Daycare Information
Business Name
License Number
Years in Business
Maximum Number of Children
Services Offered
Property & Safety Information
Type of Property
House
Apartment
Other
Describe Safety Measures in Place
Fire Extinguisher Available?
Yes
No
Smoke Detectors Present?
Yes
No
Insurance Coverage Requested
Type of Coverage
Liability
Property
Both
Desired Coverage Amount
Additional Information
Additional Notes