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Contact Details
Full Legal Names of Occupants
*
Address of Property
*
Street Address
Address Line 2
City
Alberta
British Columbia
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Northwest Territories
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Postal Code
Property Usage
*
Primary Residance
Rental
Do you currently have any type of habitational policy in place? E.g. Home, Tenant, Condo.
*
Yes
No
How many years have you had continuous insurance?
*
Name of the Insurance Company
*
Policy Number
*
Expiry Date
*
MM slash DD slash YYYY
Location Details
How many years have you lived at this add?
*
Year Built?
*
Structure
*
Apartment
Townhouse
Duplex
Unit Location/Number of Floors
*
Unit Area (Sq Ft)
*
Number of Units in building/complex
*
Construction
*
Wood-Frame
Stucco
Vinyl Siding
Commercial Occupancy?
*
Yes
No
Fire-Resistive?
*
Yes
No
Primary Heat Source?
*
Natural Gas
Electric
Any Wood Burning heat source?
*
Yes
No
Coverages and Underwriting
Contents Limit (recommended minimum is $45,000)
*
Is there a fire hydrant within 300 metres?
*
Yes
No
Is there a firehall within 8 km?
*
Yes
No
Applicant(s) Date(s) of Birth
*
Applicant(s) Occupation?
*
Do you conduct any business from the home?
*
Yes
No
Will there be any unrelated individuals living in the home?
*
Yes
No
Are any of the occupant’s smokers?
*
Yes
No
Is there a sprinkler system installed in your location?
*
Yes
No
Do you have a Burglar Alarm?
*
Yes
No
Burglar Alarm Type
*
Monitored
Local
Have you had any claims or losses in the last 5 years, insured or uninsured?
*
Yes
No
Claim / Loss details
*
Have you ever been cancelled, declined, or non-renewed home insurance?
*
Yes
No
Cancelled, declined, or non-renewed home insurance details
*