Insurance Placement Facility of Pennsylvania
190 N. Independence Mall West, Suite - 301 | Philadelphia, Pennsylvania 19106-1554
Phone: (800) 462-4972 or (215) 629-8800 | Fax: (215) 409-9100

 

 

 


HOW TO APPLY



A separate application is needed for each location. Location is defined as any separate building or structure rated separately by the Insurance Service Office.

Application Form PFP-3/ACORD 64 Pa must be used for Property Insurance coverage. Supplementary Questionaire PDWV-25 ACORD 65 PA/DE/WV is also required for fully or partially vacant or unoccupied buildings. Address Location Questionnaire PDFP-86 is required if a specific street name and house number are not assigned to the premises. See How to Apply in General Rules and Procedures for more specifics.

Separate Applications are required for Crime Coverage. See Pennsylvania Crime Insurance Program in General Rules and Procedures for more information.

To complete an Electronic Application, click here.

 

Printable and Viewable Application Forms



FOR PROPERTY INSURANCE POLICIES

 

 


Basic Property Insurance Application PFP-3/ACORD 64 Pa

Basic Property Insurance Application - Instructions PFP-3/ACORD 64 Pa Instructions

Address Location Questionnaire PDFP-86

Supplementary Questionnaire PDWV-25 ACORD 65 PA/DE/WV


FOR CRIME INSURANCE POLICIES

 

Pennsylvania Commercial Crime Application CC-200-FP

Pennsylvania Residential Crime Application CR-200-FP