 |
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| Name: |
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| Email Address: |
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| Address: |
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| City: |
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| Province: |
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| Postal Code: |
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| Phone Number: |
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Do you own your own home,
own a condo unit or rent? |
Homeowner
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Condo Owner |
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Renter/Tenant |
Estimated replacement value
of dwelling (homeowner only) |
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Estimated replacement value of
personal property (condo & renters only) |
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| Policy deductible preferred: |
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| Liability amount requested: |
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Have you had any personal property
claimed in the past five years? |
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| If yes, provide dates and full details: |
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| Date of Birth: |
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| No. of years since last move: |
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| No. of years continuously insured: |
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| Existing insurance company name: |
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| Alarm: |
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| Smokers in household: |
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| Construction Details: |
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Homeowner:
(year built, aluminum, fire resistive, frame, log, masonry, veneer, etc.
Occupancy: single family,
two family; three family) |
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Tenant:
(year built, 1-6 units or over 6 units,
fire resistive, other) |
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Condo Owner:
(year built, fire resistive, other) |
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Disclaimer |
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