Property Insurance Quote Property Insurance QuoteContact InformationName*Street #*Street Name*City*Province*OntarioPostal Codeof the location being quoted- not your mailing address if differentPhone*Email*Your date of birth*Do you have a partner?* Yes NoPartner's NamePartner's date of birthWhat is your occupation?*RetiredProfessionalLaborerRetailStudentSelf-EmployedProperty InformationType of Policy*HomeownerCondominiumTenantHard-to-place HomeownerRented Dwelling/LandlordsTownhomeWho occupies this property?*Your familyYou and an additional familyYou and two or more familiesAnother familyYou and your familyTwo other familiesThree or more other familiesUnder construction / Major renovationsVacantWho owns this property?*YouYou and a partnerA businessYears at current address:*Less than a year1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18-24 Years25-34 Years35-44 Years45-54 Years55-64 Years65 or Above YearsDescribe your home:*DetachedSemi-DetachedTownhouseRowhouseDuplex (side by side)Duplex (up and down)TriplexWhen your house was built?*20182017201620152014201320112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920built before 1920Construction Type*FrameBrick VeneerMasonryFire ResistiveRoof Type*Asphalt ShinglesClay TilesSlate TilesConcrete TilesMetal / SteelTar and GravelWood ShinglesOtherWhat year was your roof replaced?1982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018Number of stories (excluding basement):12345Is there a basement in your home?* Yes NoIs basement finished?* Yes NoWhat percent of the basement is finished?* < 25 % 25 - 50 % 50 - 75 % 75 - 100 %Do you require Sewer Backup Coverage or Overland Flood Coverage?* Yes NoType of swimming pool:Above Ground, with FenceAbove Ground, without FenceIn Ground Fiberglass, with FenceIn Ground Fiberglass, without FenceIn Ground Concrete, with FenceIn Ground Concrete, without FenceIn Ground Vinyl, with FenceIn Ground Vinyl, without FenceNO SWIMMING POOLPrimary heating source:*Central Furnace - GasCentral Furnace - OilCentral Furnace - PropaneCentral Furnace - WoodElectricHot Water / SteamCombination FurnaceHeat PumpSolarOtherAny additional heating?NoneCombination Furnace (Add-on)FireplaceFireplace InsertSolid FuelSpace Heater - GasSpace Heater - OilSpace Heater - ElectricWood Burning StoveDistance from nearest fire hydrant:*Within 1000 feet (300m)Over 1000 feet (300m)Distance from nearest fire hall:*Up to 5 miles (8 km)Over 5 miles (8 km) and up to 8 miles (13 km)Over 8 miles (13 km)How many smoke detectors do you have?012345Do you currently have a home insurance policy? Yes NoDo you currently have a mortgage on this property? Yes NoCOVERAGE REQUESTEDLiability Limit Requested*1 Million2 Million3 Million4 Million5 MillionBuilding Limit *in dollarsDeductible Requested*50010002500What is the name of your current home insurance company?What is the date you first started your home insurance policy?*How many home insurance claims have you filed in the last 7 years?* 0 1 2 3 or moreHow many Non-Sufficient Funds (NSF) incurred through payment of insurance premium occurred within the last 3 years?012345Premium Payments -methodMonthlyAnnual3 or 4 Payments OptionYear of updates & other relevant info.*please include any additional info. eg. the year systems (electrical,plumbing,heating) were updated, riders required etc.If you are human, leave this field blank.Submit
