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1. Current address

2. Address of property you are buying

3. Date of birth

4. Spouse's date of birth

5. Year home was built

6. Age of roof

7. Purchase price

8. Do you have a swimming pool?

9. Year, make, model, VIN of auto(s)

* Please provide this information for all autos

10. Drivers license number

* Please provide this information for all drivers