Referral Consent

Many mortgages require proof of insurance as a condition of closing, which means you need to have adequate insurance in place well in advance of the closing date of the purchase of your new home. works closely with InsureLine Brokers Inc. who is an insurance brokerage licensed by the Insurance Council of British Columbia to broker insurance.
Your Information
Your Name (Applicant)*
First Last
Your Phone Number*
Your Email*
- Is there a Co-Applicant?
Co-applicant's Name*
First Last
Property Closing Date*
MM slash DD slash YYYY
Purpose*
Property Type*
Property Address*
Street Address Address Line 2 City Province Postal Code
- Is your subject property also your mailing address?
Your Mailing Address*
Street Address Address Line 2 City Province Postal Code
Law Firm
Law Firm Contact
Law Firm Phone Number
Referrer's Information
Referrer's Name*
Referrer's Company*
Referrer's Email*
Your Comments
CONSENT TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY & DISCLOSURE NOTICE OF RECEIPT OF A REFERRAL FEE
As part of the mortgage application process, has collected your personal information pursuant to the terms and conditions set out in their mortgage application for the purpose of obtaining financing options for you ("Personal Information").You have requested that share your Personal Information with InsureLine Brokers Inc. to provide you with insurance quotes and information about insurance products, insurance offerings and related services. InsureLine Brokers Inc. will be paying a referral fee for having referred you to InsureLine and arranging to provide your Personal Information. Your consent to share your Personal Information with InsureLine is not a pre-condition or requirement of your mortgage application. By your consent, I/we [Applicant] & [Co-Applicant] hereby confirm that we have read and understand the items set out above and we hereby grant consent for to disclose my/our Personal Information to InsureLine for the purpose outlined above. I/We understand and agree that this is not an application form, an application for insurance or a solicitation for insurance.
Applicant's Signature*
Co-Applicant's Signature*

INSURELINE BROKERS INC. IS A FULL SERVICE INSURANCE BROKERAGE and INSURELINE MARKETING SYSTEMS INC. IS A FRANCHISOR OF INSURANCE BROKERAGES (jointly InsureLine Brokers Inc. and InsureLine Marketing Systems Inc. hereinafter referred to as “InsureLine”). MUCH LIKE A MORTGAGE BROKER, WE SHOP THE MARKET FOR THE BEST HOME INSURANCE POLICY AMONGST CANADA’S LARGEST INSURERS TO QUICKLY GET YOU GREAT COVERAGE AT THE BEST RATE!

Your Information

Referrer's Information

CONSENT TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY & DISCLOSURE NOTICE OF RECEIPT OF A REFERRAL FEE