Home Quote Tenant Quote Life Quote Get a Quote NowAuto Insurance Quote RequestGet a Quote - Auto Years continuously licensed & insured in Canada? * 123456789101112131415+ Have you had any cancellations, accidents, tickets, or gaps in insurance in the last 6 years? * Yes No First Name * Last Name * Email * Address * Address Address Address City City Province Province Postal Code Postal Code Phone * Effective Date * Do you own a home or rent? * Own a Home Rent N/AAs your broker, I am gathering this consent on behalf of the insurer who advises me that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, we may collect, use, and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law and in accordance with our privacy policies.Do you, and on behalf of others listed, authorize use to collect, use, and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settile claims, analyze business results and detect and prevent fraud?Do you agree with the following consent statement? * Yes NoVehicle Information Year * Make * Model * CoveragesHow did you purchase your vehicle? * New UsedIs the vehicle leased or financed? * Leased Financed N/ALiability * 1 million 2 millionLoss / Damage * Collision Comprehensive None of the aboveDistance Driven How many kilometres driven to work/school one way? * 051015202530+ Annual kilometres * Less than 10,00015,00020,00025,00030,000Over 30,000 Business Use * Yes NoDo You Use Winter Tires From November To April? * Yes NoIs The Car Parked In A Private Driveway? * Yes NoClick 'Add' if you like to add another vehicle.plus1 Add minus1 RemoveDriver Sex * Male Female Prefer Not To SayPrefer Not To Say Name * Birth Date * Occupation * Date License Obtained In Canada * Date First Insured In Canada * Current Insurance Company * AllstateAvivaCAAEchelonEconomicalICPEIIntactPembridgePortage MutualRSATDWawanesaOther Current Insurance Company Number of At-Fault Accidents in Last 6 Years * 012345 Number of Minor Convictions in Last 3 Years * 012345 Number of Major Convictions in Last 5 Years * 012345 Are there any other licensed drivers living in your household? * YesNo Relationship * Do You Have A CAA Membership? * Yes NoClick 'Add' if you like to add another driver.plus1 Add minus1 RemoveAdditional InformationAre you interested in any of the following insurance products? * Home Insurance Condo Insurance Tenant Insurance Life Insurance OtherOther Any additional information? If you are human, leave this field blank. Submit