West Coast Mexico Insurance – Mexico Home Insurance Online Application | Mexican Home Insurance Online Application
IMPORTANT NOTICE: This insurance will only apply in Mexico under the Mexican Legal System. No Coverage is afforded in neither the United States or Canada's legal system.
FIRST NAME
LAST NAME
DATE OF BIRTH
COUNTRY OF BIRTH
CITIZENSHIP
OCCUPATION
ADDRESS IN USA or CANADA
CITY
U.S. STATE, CANADIAN PROVINCE or MEXICO STATE:
POSTAL CODE
PHONE # (1)
PHONE # (2)
PHONE # In Mexico
EMAIL
2ND EMAIL
HOW DID YOU HEAR ABOUT US OR FIND US? ?
IMPORTANT INFORMATION ABOUT THIS INSURANCE
WHEN AN INSURANCE POLICY IS ISSUED, IT WILL BE BASED ON THE INFORMATION PROVIDED ON THIS APPLICATION. UNDER MEXICAN LAW, ANY MATERIAL MISREPRESENTATION OR CONCEALMENT WILL INVALIDATE THE INSURANCE. PLEASE BE ACCURATE.

HOW MUCH TIME OF THE YEAR ARE YOU SPENDING IN MEXICO?

PROPERTY USE? (SELECT ONE)

PRIMARY RESIDENCE    VACATION USE

REQUESTED EFFECTIVE DATE

  12:01 AM
DETAILS ABOUT THE OWNER/ENTITY WHO HOLDS TITLE ON THE INSURED LOCATION
ENTITY TYPE INSURED NAME (This is the Registered Name on Your Mexican Deed or Fidiecomiso)
  
ADDRESS CITY
U.S. STATE, CANADIAN PROVINCE or MEXICO STATE POSTAL CODE
ADDITIONAL INTERESTS: MORTGAGEE (MG) AND/OR ADDITIONAL INSUREDS (AI)         YES NO    
PHYSICAL ADDRESS OF INSURED PROPERTY IN MEXICO
MEXICO PHYSICAL ADDRESS (Include Lot&/or Unit#) DEVELOPMENT, COMMUNITY OR BUILDING NAME MEXICO CITY
MEXICO STATE MUNICIPALITY POSTAL CODE
DETAILS ABOUT THE INSURED LOCATION
                        

DWELLING REPLACEMENT COST $$ MAIN STRUCTURE SQ. FT. (AIR CONDITIONED SPACE) LOT AREA Total SQ. FT.
$
ORIGINAL YEAR BUILT WHAT YEAR DID YOU TAKE POSSESION? # OF STORIES/LEVELS within HOME or CONDO?
STRUCTURE WALLS INTERIOR WALLS & CEILINGS EXTERIOR ROOF
OTHER STRUCTURES (DETACHED FROM MAIN STRUCTURE) YES NO  
HAVE YOU EVER UPDATED OR REMODELED YOUR HOME OR CONDO? YES NO
HAVE YOU EVER HAD INSURANCE PROTECTION ON THIS PROPERTY? YES NO
HAVE YOU HAD ANY CLAIMS IN THE LAST 5 YEARS THAT HAVE BEEN FILED WITH YOUR INSURANCE COMPANY? YES  NO
REQUESTED COVERAGES AND LIMITS OF LIABILITY
SECTION

COVERAGES

ENTER REQUESTED LIMITS OF COVERAGE

PROPERTY COVERAGES
DWELLING VALUE
Replacement Cost
$ USD - EXCLUDING DWELLING COVERAGE OFFERS NO STRUCTURAL PROTECTION
PERSONAL PROPERTY-REPL. COST
10% to 50% of Coverage A
$ USD - ENTER LIMIT OF COVERAGE REQUESTED
ADDITIONAL LIVING EXPENSE
Up to 20% of A or 40% of C
INCLUDE EXCLUDE
LOSS OF RENTS
Up to 10% of A or 20% of C
INCLUDE EXCLUDE
DEBRIS REMOVAL
Up to 10% of A or 20% of C
 INCLUDED
LIABILITY PERSONAL LIABILITY IN MEXICO- LIMIT PER OCCURANCE
$300,000  $500,000  $1,000,000  $2,000,000  
LIABILITY (MEDICAL) MEDICAL PAYMENTS IN MEXICO
 INCLUDED
CATASTROPHIC LOSSES
EARTHQUAKE & VOLCANIC ERUPTION  
INCLUDE EXCLUDE
HURRICANE, WINDSTORM & HAILSTORM, FLOOD, TIDAL WAVES  
INCLUDE EXCLUDE
SCHEDULED VALUABLES
JEWELRY, SILVERWARE, ART & OTHER VALUABLE PROPERTY PER ATTACHED SCHEDULE
YES NO
SOLAR EQUIPMENT DO YOU HAVE ANY SOLAR PANEL OR RELATED EQUIPMENT TO BE COVERED?
YES NO
1. HOW MANY SOLAR PANELS DO YOU HAVE ON YOUR PROPERTY?
2. ARE YOUR SOLAR PANELS ATTACHED AND BOLTED DOWN TO THE MAIN DWELLING STRUCTURE? YES NO
3. ARE YOUR SOLAR PANELS NOT ATTACHED TO YOUR MAIN DWELLING STRUCTURE? YES NO
4. WHERE ARE THE BATTERIES, CONVERTORS AND OTHER RELATED SOLAR EQUIPMENT LOCATED?
5. TO REPLACE THE SOLAR PANELS AND EQUIPMENT RELATED TO YOUR SOLAR SYSTEM PLEASE PROVIDE A VALUE? $

SPACE FOR ADDITIONAL INFORMATION, COMMENTS OR NOTES:

UNDERWRITING INFORMATION – SELECT MOST APPROPRIATE ANSWER– ALL 16 ITEMS MUST BE COMPLETED
OCCUPANCY
1. Property Type
2. Owner Use and Rental
PROTECTION
3. Occupancy Vacancy
4. Fire Detection
5. Security
6. Does your Home or Condo have Bars on the Windows? Yes No
7. Is the Home or Condo Located in a Gated Community? Yes No
8. Does your Home or Condo have a Central Alarm System either Local or Monitored Yes No
9. Exterior & Safe Protection
10. Fire Department
EXTERNAL
11. Water Supply
12. Swimming Pool/SPA
13. ARE THERE ANY STRUCTURES BETWEEN YOUR HOME/CONDO AND THE SEA-LEVEL LINE?
YES  NO
14. FLOOD & TIDAL WATER
15. IN THE DROP DOWN SELECT THE CLOSEST ANSWER TO THE DISTANCE YOUR PROPERTY IS LOCATED AWAY FROM ANY BODY OF WATER?
16. WEATHER & STORM SHUTTER PROTECTION
A FEW MORE QUESTIONS TO UNDERSTAND THE SCOPE OF YOUR EXPSOURE TO RISK IN MEXICO?

1. I AM INTERESTED IN INTERNATIONAL LIFE INSURANCE TO SAFE GUARD MY FAMILY OR BUSINESS PARTNER/S TO PAY OFF ANY OUTSTANDING LOAN ON MY PROPERTY. (A MEDICAL EXAM MAY NOT BE REQUIRED – EASY UNDERWRITTING)::

Yes  No
2. I OWN VEHICLES IN MEXICO:

3. I AM INTERESTED IN MEXICO & GLOBAL TRAVEL HEALTH PROTECTION IN THE EVENT OF AN ACCIDENT OR ILLNESS WHILE I'M OUTSIDE MY COUNTRY OF RESIDENCE FOR MYSELF AND OR MY FAMILY (AIR EVACUATION INCLUDED):

Yes  No

4. I LIVE IN MEXICO 6 MONTHS OF THE YEAR OR MORE AND I WOULD LIKE TO SEE OPTIONS FOR EXPAT MAJOR MEDICAL PROTECTION INCLUDING AIR EVACUATION (GLOBAL HEALTH PROTECTION WITH NO BORDERS- U.S. COVERAGE INCLUDED):

Yes  No

5. I OWN OR PLAN ON PURCHASING A WATERCRAFT AND WOULD LIKE TO KNOW MORE ABOUT WATERCRAFT INSURANCE & LIABILITY PROTECTION IN MEXICO. (CALIFORNIA & GLOBAL NAVIAGATIONAL LIMITS – OK):

Yes  No

SPACE FOR ADDITIONAL INFORMATION, COMMENTS OR NOTES:

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