The following forms have been designed to ensure you receive the most accurate home insurance quote possible. Please make sure you accurately complete all required fields on each screen. Move between fields with mouse or tab key. When finished click the "Submit Information" button. We will contact you within the next 48 hours.

PERSONAL INFORMATION

Home Address Apt. Suite

City/Town Province BC AB SK MB ON PQ NB NS NF PE NW YK Postal Code

Home Telephone Business Telephone Fax Telephone

Email Address

HOME INFORMATION

What type of home insurance do you need? Tenant Condominium unit owner Homeowner

How old are you? 18-24 25-39 40-49 50-54 55+

How long have you had a home insurance policy? Never 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years or more

How many property claims have you had in the last 10 years? No Claims 1 2 3 or more

How many years has it been since your last property claim? No Claims less than 1 year 1 2 3 4 5 6 7 8 9 10 or more

Have you ever had your home insurance refused or cancelled? no yes

Enter the postal code of the dwelling you want to insure.

City where the dwelling to be insured is located?

Describe your dwelling Detached Semi detached Townhouse Rowhouse Duplex (side by side) Duplex (up and down) Triplex High Rise Commercial Mobile Home Unoccupied Vacant Other

What is the replacement value of your personal property? $25,000 $26,000 $27,000 $28,000 $29,000 $30,000 $31,000 $32,000 $33,000 $34,000 $35,000 $36,000 $37,000 $38,000 $39,000 $40,000 $41,000 $42,000 $43,000 $44,000 $45,000 $46,000 $47,000 $48,000 $49,000 $50,000 $51,000 $52,000 $53,000 $54,000 $55,000 $56,000 $57,000 $58,000 $59,000 $60,000 $61,000 $62,000 $63,000 $64,000 $65,000 $66,000 $67,000 $68,000 $69,000 $70,000

How many roommates, roomers or boarders do you have? 0 1 2 3 or Greater

How old is your dwelling? less than 1 year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 years 11 years 12 years 13 years 14 years 15 years 16 to 20 years 21 to 25 years 26 to 30 years 31 to 35 years 36 to 40 years 41 to 45 years 46 to 50 years greater than 51

What is the construction type of your dwelling? Solid brick (2 or 3 brick rows) Brick veneer (wood/metal/brick frame) Wood/metal frame or aluminium siding Vinyl siding Stucco Fire Resistive Other

What is the primary method of heating in your dwelling? Gas Oil Electric Propane Solar Wood Other

What additional heating do you use to heat your dwelling? Not applicable Wood or pellet stove Fireplace insert Space heater Other

What type of alarm system do you have in your dwelling? No alarm Local burglar Local burglar and fire Centrally-monitored burglar Centrally-monitored burglar and fire

Is your dwelling located within 300 m (1000 ft) of a fire hydrant? yes no

Is your dwelling located within 8 km (5 miles) of a fire hall? yes no

Do you operate a home-based business from your dwelling? no yes

COVERAGE OPTIONS

Contents coverage? All perils Named perils
If you select the "All perils" option, your replacement value must be a minimum of $30,000.

Liability coverage - Choose an amount $1,000,000

Choose a deductible $500 $1,000

Water damage including sewer backup option Apply coverage No coverage

Jewellery option No additional coverage $500 $1000 $1500 $2000 $2500 $3000 $3500 $4000 $4500 $5000 $5500 $6000 $6500 $7000 $7500 $8000 $8500 $9000 $9500 $10000 $10500 $11000 $11500 $12000 $12500 $13000 $13500 $14000 $14500 $15000

Fur option No additional coverage $500 $1000 $1500 $2000 $2500 $3000 $3500 $4000 $4500 $5000 $5500 $6000 $6500 $7000 $7500 $8000 $8500 $9000 $9500 $10000 $10500 $11000 $11500 $12000 $12500 $13000 $13500 $14000 $14500 $15000

DISCLAIMER:
All information is held in strict confidence for rating purposes only. No information is given or sold, other than to the insurance company that issues your policy. Our quote is based solely on the accruacy and completeness of the info you provide us. Companies verify all info and may adjust premiums for any changes.