Home Insurance Quote





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 Information:
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:
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