Property Insurance Quote Form


Name:
Address:
City:
Province:
Postal Code:
Home Phone:
Work Phone:
Email:
Employer:
Contact Method:   By Phone
  By Email


Property Insurance Quote Form
Number of properties:
You must submit a seperate form for each additional property.
Please check each property coverage required:
Tenants
Homeowners
Condominium		 Seasonal Dwelling
Trailer/Minihome
What is the Personal Liability Limit?:
$1,000,000   $2,000,000
Amount of property insurance you currently carry:
Have you suffered any losses in the last three years? If yes provide details:
No   Yes:  
Does your policy cover valuable articles? If so, please provide total value for each section:
Jewellery: $
Fine Arts: $
Sports Equipment: $
Computer Equipment: $
Other: $
Expiry Date of Current Policy:
Deductible amount on your current policy:
In what year was your property built:
How is your property heated?:
Electric   Oil Heat/Furnace   Other
Other sources of heat?:
Woodstove   Propane Stove   Wood Pellet Stove
Fireplace Insert   Other
Type of construction:
Frame   Brick   Fire Resistive
Is there commercial occupancy in your residence? If yes provide details:
No   Yes:  
Type of home:
Single Family Home   Semi-Detatched Townhouse