Property Insurance
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
Is property equipped with an alarm?
If yes, is alarm
Are you within 300 m of a hydrant?
Yes     No
Yes     No
Are you within 8 km of a firehall?
Yes     No
Yes     No
   
Discount Information
I am mortgage-free
I am a non-smoker
   
Amount of coverage required
Building:
Contents:
Liability:
Deductible:
   
Recent claims:
Type: Date (mm/yyyy) Location involved
#1:
#2:
#3:
Comments:
   
 

Disclaimer
This is a request to provide a quote only and is not an insurance policy. It is not an offer of insurance. Further information may be required in order for a complete quote to be provided. This quote request contains some information about coverage offered but it does not list all of the conditions and exclusions that apply to the described coverage. The actual wording of the policy governs all situations.

This quote request is only available to persons resident in the Province of Ontario.

The products described are subject to change without notice at any time.