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Car Insurance
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Home Insurance
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Home Insurance
Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Do you own your own home,
own a condo unit or rent?
Homeowner
Condo Owner
Renter
Year built:
Protection Grade:
fire hydrant within 300 meters
fire hall within 8 kms
fire hall 8 to 13 kms away
no fire hall within 13 kms
Estimated replacement value
of dwelling (homeowner only)
Estimated replacement value of
personal property (condo & renters only)
Primary heat source:
electric
oil
wood
natural gas
other
Secondary heat source:
electric
oil
wood
natural gas
other
Do you have a mortgage?
Yes
No
Have you been continuously insured for the last 3 years?
Yes
No
Policy deductible preferred:
$200
$300
$500
$1000
Liability amount requested:
$500 000
$1 million
$2 million
Have you had any personal property
claimed in the past three years?
Yes
No
Addition Info:
Disclaimer
