Home · Request a Quote · Home Quote
Home Link Sitemap Link
About Us Insurance Link FAQ Link Our Companies Link Privacy Statement Link Request a Quote Contact Us Link
 

Home Quote

   
Name:
Address:
City:
Province:
Postal Code:
Phone Number:
Email Address:
Have you ever had insurance cancelled
or refused?
Yes     No
Do you currently insure your property?
Yes     No
Number of years prior insurance:
Expiry date with present Insurer
(dd/mm/yyyy)
What is your date of birth? (dd/mm/yyyy)
 
Property #1 Property #2
Property type:
Use:
Do you
Year built:

 

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

Furnace
Roof
Wiring
Plumbing
Furnace
Roof
Wiring
Plumbing

 

If property under 20 years old?

Age of oil tank:


Is the oil tank:
inside   outside

Do you burn wood?
Yes  no

If yes, number of cords:

Type:
wood furnace 
wood stove
wood combination furnace

Age of oil tank:


Is the oil tank:
inside   outside

Do you burn wood?
Yes  no

If yes, number of cords:

Type:
wood furnace 
wood stove
wood combination furnace
Wiring?
What type of foundation?
Is property equipped with an alarm?
If yes, is alarm
How many families ?
Are you within 300 m of a hydrant?
Yes     No
Yes     No
Are you within 13 km of a firehall?
Yes     No
Yes     No

Do you run a business from your home?

Yes     No
Yes     No
What type of business?
Discount Information  
I am mortgage-free
   
Amount of coverage required  
Building:
Contents:
Liability:
Deductible:

Is water damage and sewer backup required?

Yes     No
Yes     No
Recent claims:
Type: Date (mm/yyyy) Location involved
#1:
#2:
#3:
Comments: