Quotes

Auto Insurance

Mandatory fields are marked with *
When should coverage start:
Are you currently insured:
Have you ever had insurance cancelled or refused*:
Do you currently insure your car:
If not, have you had insurance for 12 consecutive months within the last 6 years:
Driver Information
#1 #2 #3
Name:
Drivers License #:*
Years licensed in Canada:*
Date G1 Obtained:
Date G2 Obtained:
Date G Obtained:
Sex:
Marital Status:
Driving School:
Retired?
Minor traffic convictions in the last 3 yrs:
Major traffic convictions in the last 3 yrs (careless or impaired driving, refusing breathalyzer, etc.):
Have any of above drivers had their licenses suspended or revoked in the past 3 years:
Have any of the drivers above had accidents or insurance in the past 6 years*:
Claims Information:
Claims Date Driver Involved
#1:
#2:
#3:
Vehicle Information
Vehicle #1 Vehicle #2
Vehicle Make:
Year:
Model:
Style:
Use:
Kilometres driven per year:
Who is primary driver:
Coverage Required:
Vehicle #1 Vehicle #2
Liability:
Collision deductible:
Comprehensive deductible: