To get a no-obligation quote on your property insurance, please complete the following form and submit it to our office. We will contact you within the next two business days. Please note: We can only provide insurance for residents of Alberta, Canada.
For your convenience, the property quote form can be used for home, condominium, or tenant's coverage.
Tell us about yourself...
Please Note: It is imperative that all fields be completed for us to give you an accurate quote.
Name:
Address:
City:
Province:
Postal Code:
Phone:
E-mail:
Have you ever had your insurance cancelled or refused?
Yes No
Do you currently insure your property?
If yes, what is the name of the insurance company?
What is your current insurance policy #?
If no, have you had insurance within the past 6 years?
If yes, what was the name of the insurance company?
What was your previous insurance policy #?
When would you want the coverage to start?
What is your date of birth?
Tell us about your property...
Is it a:
House Freehold Townhouse Condo Townhouse Condo Apt. Rented Apt.
Ontario
Is this your:
Principal Home Cottage (year-round) Cottage (Summer Only) Rented Property Other
Do you:
Own it Rent it
When was it built:
If it is over 20 years old, have any of these been updated or replaced:
Roof Year Wiring Year Furnace Year Plumbing Year
Purchase price/current value of home:
Total sq. footage of living area:
Number of stories:
Exterior Walls:
Brick Stucco Aluminium Other material
Is there a business in the home?
If yes, please provide details:
Is there an alarm system:
None Burglar Only Fire Only Burglar & Fire
If yes, is it:
Local Only Monitored
Is your property located within:
300m of Fire Hydrant 8 km of Fire Hall Neither
Coverages & Deductibles
Please fill in the coverages you presently have. The best place to find this information is on your current insurance policy. If a section does not apply to you, please leave it blank or fill in "n/a". If you are uncertain of an answer, mention it in the comment section at the bottom.
Building Amount:
$
Contents Amount:
Liability Amount:
$500,000 $1,000,000 $2,000,000
Deductible:
$300 $500 $1,000
If you have any extra coverages, such as special coverage for expensive jewellery, boats, furs, etc., please make a note of it in the comments section below.
Claims Information
Type of Claim:
Date of Claim mm yyyy
Location Involved:
1.
None Break-in Fire Jewelery Lost/Stolen Water Damage Other
None Location1 Location2
2.
3.
Comment:
Your Privacy You are authorizing that we collect, use or disclose your personal information contained on this information form as well as any additional information that we may obtain about you and other listed beneficiaries based on the information you have disclosed to us, (for example confirming your claims history or checking with motor vehicle agencies), for the purpose of providing you with this quote. By submitting this information form you also confirm that you have obtained the permission of all other potential beneficiaries listed on this information form for the collection, use and disclosure of their Personal Information for the purpose of providing you with this quote. Submission of this form does not constitute an application for insurance. Do you consent? Yes No
Thank you for taking the time to fill out this form. Select the "Submit" button below and we will contact you within the next two business days. Our quote will include the coverages you selected plus the standard Accident Benefits coverages. We will include the cost of popular optional coverages with our quotation. Optional Accident Benefit coverages can be upgraded by consulting one of our brokers.
* Coverage is subject to the insurer's underwriting policies.
** To learn more about the protection of your personal information, consult Privacy & Legal.
