Mexican Auto Insurance Home Page

Mexican Homeowners Insurance Application

Please complete and submit the interactive form below
or print the form, complete it and fax or mail to:

Lewis and Lewis Insurance Agency, Inc.
11900 West Olympic Blvd., #475
Los Angeles CA 90064
Phone (310) 207-7700 or (800) 966-6830
Fax (310) 207-7701

* Named Insured
* First Name Middle Name * Last Name
Loss Payee & Loan #
* Email
Cellular Telephone
Mexican Telephone
Fax Number
Mailing Address
City
State/Province
Zip/Postal Code

Year the House was built

Number of Stories/Levels Ocean

This property has a total number of completely enclosed Buildings equal to

This property has a total number of other structures equal to

Is the Applicant the OWNER, LANDLORD, RENTER OR MORTGAGEE?

Is the Property a House, Townhome, Condominium or Cabin?

Is the Property use a Primary Residence, Vacation Use, Weekend Use or available for Lease/Rent?

Please state the Location of the Property in Mexico, Street Address, City, Municipality, State and Mexican Postal Code

please provide complete address as shown in the title documents
Beach Front Property?

1. Is your property less than 500 Meters from a Sea or Ocean?

2. Is your property less than 250 Meters from a River, Lake or Lagoon?

3. What Distance in Meters is your property above the Sea Level Line?

4. How many structures between your Home and the Sea Level Line?

Security Protections

24 Hour Guards
Central Alarm
Local Alarm
TV Circuit

Fire Protections

Local Guard W-TV Circuit
Smoke Detectors
Sprinklers
Extinguishers

Main Dwelling and Insured Values Needed:
MAIN DWELLING Value to Rebuild (USD$)
$USD
OTHER STRUCTURES Value to Rebuild (USD$)
$USD
Accidental Glass Breakage MAIN Dwelling
Yes No
Special Structures

Maximum Limit available $50,000
Accidental Glass Breakage Desired limit Main Dwelling Building
$USD

Accidental Glass Breakage Desired limit Special Structures
$USD

CONTENTS Real Replacement Value of (USD$)
$USD
THEFT Value of Contents to Insure for (USD$)
$USD
THEFT List of Expensive or Hard to Replace Contents (items with individual values exceeding U.S. $1,500.00)
DESCRIPTION Serial No.
Date Purchased
VALUE
Personal Articles Floater
Yes No
Maximum Limit available $750.00
Please provide a description of any Jewelry; Gold; Silver; Weapons; Collectables; Watches; Furs; Precious Stones as these need to be scheduled for CONTENTS COVERAGE as well as THEFT COVERAGE to be applicable to them.
$USD
Money and Securities
Yes No
Maximum Limit available $2,000
$USD
Electrical Household
Appliance Coverage?
Yes No
Maximum Limit available $1,000,000
$USD
LOSS OF RENTS (USD$)
$USD
LIABILITY
Civil General Liability
Yes No
Maximum Limit available $3,000,000
$USD
Square Footage of Main Dwelling Building
Square Footage of Guest House, Garage and Storage Buildings
Are all Buildings Fully Enclosed?
Yes No
Only completely enclosed Buildings are insurable.
Building Material of main DWELLING WALLS
If other please describe?
Building Material of main DWELLING ROOF
If other please describe?
What Percentage of the Main DWELLING Building Roof is Palapa?

Palapa means "thatch covered structure" of any shape constructed of natural palm leaf.
List other Structures that are dethatched from the Dwelling

please provide complete address as shown in the title documents
Building Material of OTHER STRUCTURES WALLS
If other please describe?
Building Material of OTHER STRUCTURES ROOF
If other please describe?
Additional:
Window Storm Shutters for all Buildings?
Yes No If other please describe?
Do you have a Pool on the Property?
Yes No
If yes, please describe and provide a value for each
Do you have Porches on the Property?
Yes No
If yes, please describe and provide a value for each
Do you have Palapa on the Property?
Yes No
If yes, please describe and provide a value for each
Specify each type of construction and its value at your property. As only items specified and that are specifically scheduled on your policy would be covered.
Construction Item Value $USD
Garage
Guest house CASITA
Storage building
Porch
Portico
Deck
Concrete Slab
Driveway
Metal chimneys
Windmills and Air-driven Pumps
Cooling towers
Towers and Transmission Antennae
Receiving Antennae; SATELLITE
SOLAR PANELS and Electric Substations
Signs
Sports Installations
Meteorological stations
Gardens and Decorative Constructions
Fixed Garden Furniture
Docks and piers
Staircase
Terrace
Walls
Roads; paved Streets; Sidewalks; and/or Patios belonging to the insured.
Holding Tanks; Cisterns; Liquid Depositories and their contents
Other Constructions
LOSS HISTORY PAST 5 YEARS
Please State the Date of Loss, Description, Amount Paid, Insurance Carrier Name and the Preventative action you have taken

Photos

* Please send an exterior photo of the home showing the roof and an interior photo of the home showing the top floor ceiling. Please send an exterior photo of any other structure needing insurance. Please e-mail these photos to Lewis and Lewis:
JimLewis@MexicanAutoInsurance.com

To Complete Your Application

Once you receive a quote and wish to proceed, please contact our office by telephone with your credit card information so that we may complete your application. This policy is subject to a minimum premium. Policy fee and broker fee are fully earned and non-refundable.

If you have any further questions, please call 1 (800) 966-6830 from the U.S./Canada or (310) 207-7700 from Mexico, EXTENSION 305

 

IMPORTANT TERMS

SECTION I. PROPERTY
Covers the replacement cost of the main structure and additional structures such as fences, swimming pools, exterior patios, stairs, independent retaining walls, guest houses within the same premises/lot/land. Maximum limit: $5,000,000 USD (combined with Contents section).
SECTION II. CONTENTS
Covers the replacement cost of household goods and other inherent contents of a residential home, as well as improvements and betterments for condo units.
SECTION III. CONSEQUENTIAL LOSSES
a) Debris Removal: Covers the expenses to remove debris from the affected properties cause as a consequence of a risk covered. (Maximum limit: 5% of the limit of building and contents).
b) Extraordinary Expenses: Covers the expenses incurred by the Insured (like: house or apartment rental, moving expenses, emergency storage, etc- in case the affected property cannot be occupied after a covered loss. (Maximum limit: 5% of the limit of building and contents. Maximum period: 4 months)
c) Loss of Rent: Covers the income that the Insured will had obtain if the property had been occupied by tenants under a lease agreement and is vacant due to covered loss.(Maximum limit: $50,000 USD Maximum period: 4 months)
EARTHQUAKE AND *HMP ARE EXCLUDED FOR LOSS OF RENT COVERAGE.
Coverage’s for section I, II and III: All Risk-Mexican Form, plus Earthquake (Optional) and *HMP/FHM (Optional)
Deductibles: Only for Earthquake and *HMP/FHM. Apply over the limit of Building + Contents.
Co-Pay: Only for Earthquake and *HMP/FHM. Apply over the amount of the loss.
Special Clauses: Replacement cost for all coverage and First Risk Insurance except for the Earthquake coverage.
HMP/FHM: (Hydro-Meteorological Phenomenon includes the following perils, Mudslide, hail, frost, hurricane, flood, flood by rain, wave wash/tidal wave)
SECTION IV. CIVIL GENERAL LIABILITY
Maximum limit: $3,000,000 USD
Coverage: Homeowners Liability for damages to third parties. Mexican jurisdiction only.
*Worldwide coverage (this coverage can only be offered if the Insured permanently resides in Mexico)
Major Exclusions: Punitive Damages, exemplary damages or vindictive damages, suits outside Mexico (if worldwide coverage is not covered).
SECTION V. BURGLARY
Maximum limit for Item I (General household contents): 80% of Contents limit.
Maximum limit for Item II (Art and Jewelry): 50% of the limit in Section I (Only applicable to permanent residents in Mexico)
Coverage: Theft of contents within premises with violence and/or assault
Major Exclusion: Mysterious Disappearance.
SECTION VI. MONEY AND SECURITIES
Maximum limit: $2,000 USD
Coverage: Cash/Valuable Papers
Major Exclusion: Mysterious Disappearance.
SECTION VII. ACCIDENTAL GLASS BREAKAGE
Maximum limit: $50,000 USD
Coverage: Accidental glass breakage.
SECTION VIII. ELECTRICAL HOUSEHOLD APPLIANCES
Maximum limit: $1,000,000 USD
Coverage: Inexperience, Carelessness, Direct action of electrical energy.
Major Exclusions: Gradual wear or deterioration, Esthetic defects.
SECTION IX. PERSONAL ARTICLES FLOATER (Portable items of personal use outside the covered premises).
Maximum limit: $750 USD
Coverage: Portable articles or property of the Insured while in use and temporarily outside the covered premises.
Major Exclusions: Mysterious Disappearance.
SECTION X. FAMILY ASSISTANCE
Coverage: Home assistance, Travel assistance, Extension of assistance, MEDITEL, Final Expenses, Legal Assistance
This is only a summary of the main terms & conditions. It does not represent the full extent of the Mexican policy terms & conditions.
For further detail, please request or download the general conditions of the policy.

Revision 20150919