Home/Condo/Tenants Insurance

Name:(Required)

Address:(Required)

City:

Province:

Postal Code:

Phone Number:

Email:

Number of years prior insurance:

Have you ever had insurance cancelled or refused:(Required)

Yes

No

Do you currently insure your property:

Yes

No

Expiry date with present Insurer:

What is your date of birth:

First Property

Property Type:

Use:

Do you:

Year Build:

If property over 20 years old, which of the following have been replaced:

Furnace

Roof

Wiring

Plumbing

Is property equipped with an alarm:

If yes, is alarm:

Are you within 300 m of a hydrant:

Yes

No

Are you within 13 km of a firehall:

Yes

No

Discount Information

I am mortgage-free:

I am a non-smoker:

Amount of coverage Required

Building:

Contents:

Liability:

Deductible:

Recent Claims

First Claim

Type:

Date:

Location Involved:

Second Claim

Type:

Date:

Location Involved:

Third Claim

Type:

Date:

Location Involved:

Comments:

Home/Condo/Tenants Insurance