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| Preferred Method of Contact: |
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| This quote request is for detached homes (1 or 2 family). |
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If you currently have insurance, please provide current insured limit |
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| Do you smoke: |
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| Do you have a monitored burglar alarm?: |
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| Do you have a monitored fire alarm?: |
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| Do you have sprinklers?: |
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| Do you have a mortgage/secured line of credit on the property: |
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| Was your prior policy canceled for non payment: |
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| Have you ever been cancelled, declined, or refused personal insurance: |
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| Kilometers to the nearest Fire Hall: |
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| Is Fire Hall: |
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| Distance to the closest fire hydrant: |
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| Solid Fuel Burning Stoves or Fireplace Inserts in the home: |
Do not count fireplaces except inserts |
| Solid Fuel Burning Units are for: |
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| Oil tanks above or underground: |
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| Dog owner: |
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| Live in employees: |
Nannies, caretakers etc. |
| Short-term rentals of property to others: |
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| Any roomers, boarders, or exchange students living in the home: |
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Exclude basement & attached garage |
| Basement Type: |
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| Building Construction Type: |
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| Building Construction Quality: |
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| Building Shape: |
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| # of Full Bathrooms: |
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| # of Half Bathrooms: |
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| Garage Type: |
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| Garage # of Cars: |
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| Crawl Space: |
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| Finished Attic: |
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| Room over Garage: |
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| Swimming Pool: |
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| Hot Tub: |
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Please describe, including sq ft area(s) |
| Has the home been completely gutted (new plumbing, wiring)?: |
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| Home listed on any Historic Registry: |
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| Wiring Main Panel Amperage: |
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| Wiring Panel Type: |
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| Wiring Updated: |
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| Wiring Material: |
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if applicable |
| Plumbing Types: |
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| Plumbing Updated: |
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if known |
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Please advise of oldest installed hot water tank or year of on-demand system installation |
| Primary Heat: |
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if applicable |
| Primary heating system serviced annually: |
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| Primary Roof Material: |
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| Reverse slope driveway: |
A reverse slope driveway is one that leads downward from a public street to a parking area, such as a below-grade garage. |
| Cannabis grown at this location: |
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| aBusiness activities conducted from the unit/dwelling: |
If you do not have another primary business location your business is considered to be operated from your home. |
| Scheduled Jewellery Coverage Required: |
Most policies include a limit of coverage for jewellery of $6000 or less subject to the policy deductible. Please advise if additional coverage is required. |
| Scheduled Bicycles Coverage Required: |
Most policies include a limit of coverage for bicycles of $1000 to $2500 per bike (or less) subject to the policy deductible. Please advise if additional coverage is required. |
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Please use this area to tell us anything else you feel is important |
| front & back if available |
| If you want a straight comparison to your current coverage, please upload a copy of your current policy. Feel free to white out premiums, though it is our company policy to provide the best terms available! |
| To confirm you aren't a bot! |
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