Auto Quote Tenant Quote Get a Quote Now Homeowner's Quote Request Get a Quote - Home Have you ever had any cancellations, claims, or gaps in insurance? * Yes No Email * Name * Address * Address Address Address City City Province Province Postal Postal Phone * Effective Date * Date of Birth * Do you agree with the following consent statement? * Yes No As 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? Insured Years of continuous home insurance * 1 2 3 4 5 6 7 8 9 10+ Date since continuously insured on home or tenant policy? * Current Insurer * Do you operate a business out of your home? * Yes No Home-Based Business Details Please provide details on business. * General Distance to the nearest fire hydrant? * Within 150 meters Within 300 meters Unprotected Distance to the nearest fire hall? * Within 5 kilometers Within 8 kilometers Within 13 kilometers Over 13 kilometers Do you have a mortgage? * Yes No Building Information Square footage excluding the basement? * Year built? * Style of Home? * Bungalow Split Entry Semi-Detached One & a Half Storey Two Storey One Level Tri-Level Townhouse Other Primary Exterior Siding * Vinyl Wood Brick Cedar Other Bathrooms Number of Full Bathrooms * 0 1 2 3 4 5 Number of Half Bathrooms * 0 1 2 3 4 5 Basement Finished, Partially Finished, or Unfinished Basement? * Finished Partially Finished Unfinished Square footage? * Do you have a garage? * Yes No Garage Is it Attached or Detached? * Attached Detached Square footage? * Year built? * Additional Structures Are there any additional structures on the property? i.e. shed, garage, swimming pool, etc. * Yes No If yes, please provide year built, square footage, construction type, exterior siding, and roof material for ALL additional structures. * Dates / Details Occupied Since? * Primary Heating Details? * Furnace - Oil Electric Heat Pump Other If Furnace - Oil, what is oil tank year? If Furnace - Oil, where is the oil tank located? Inside Outside If Furnace - Oil, what is the oil tank construction type? Double-walled Steel Fibreglass Other Year the heating was last updated? * Chimney Type? * Metal Brick None Do you have a secondary heat source? * Yes No Secondary Heating Details Type? * Electric Wood Stove Pellet Stove Fireplace Fireplace Insert Heat Pump Other Year the heating was last updated? * Chimney Type? * Metal Brick None Roofing Details Year that the Dwelling's roof was last updated? * Roof Material * Ashphalt Shingle Metal Other Plumbing Details Year that the plumbing was last updated? * Plumbing Type? * Copper Plastic Kitec Cast Iron Mix - Copper/Plastic Other Septic System? * Yes No Do you have a Hot Water Tank? * Yes No Hot Water Tank Year that the Hot Water tank was last updated? * Electrical Details Year that the Electrical Service was last updated? * Type of wiring? * Copper Aluminum Knob and Tube Service? * 60 AMP 100 AMP 200 AMP Year that the panel was last updated? * Type of panel? * Brakers Fuses Claims Number of claims on any property owned within the last 6 years? * 0 1 2 3 4 5 Additional Information Any additional information? Submit If you are human, leave this field blank.