Home Insurance (Homeowner, Condominium, Tenant)
Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Do you own your own home,
own a condo unit or rent?
Homeowner
Condo Owner
Renter/Tenant
Estimated replacement value
of dwelling (homeowner only)
Estimated replacement value of
personal property (condo & renters only)
Policy deductible preferred:
Liability amount requested:
Have you had any personal property
claimed in the past five years?
Yes     No
If yes, provide dates and full details:
Date of Birth:
No. of years since last move:
No. of years continuously insured:
Existing insurance company name:
Alarm:
Yes     No
Smokers in household:
Yes     No
Construction Details:  
Homeowner:
(year built, aluminum, fire resistive, frame, log, masonry, veneer, etc.
Occupancy: single family,
two family; three family)
Tenant:
(year built, 1-6 units or over 6 units,
fire resistive, other)
Condo Owner:
(year built, fire resistive, other)
   
 

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