Home Insurance
Claims Free past 5 years
Claims Free past 3 years
Monitored Alarm: (Fire)
Monitored Alarm: (Burglary)
Mortgage Free
Indicate what Discounts you would qualify for:
Wood Stove
Pellet Stove
Any Auxiliary Heating:
Yes
No
Yes
No
Yes
No
Any Galvanized Plumbing:
Any Knob and Tube Wiring:
Any Aluminium Wiring:
AMP’s:
Wiring Breaker or Fuses:
Age of Oil Tank (if applicable):
Date Furnace was replaced:
Date Roof was last reshingled:
If over 25 years old, please provide the following:
Age of Dwelling:
Any scheduled articles (i.e, jewelry, watercraft, etc): Describe briefly
Name of present or prior Insurance Company:
Number of years continuously insured:
Details of Prior Insurance Coverage: Describe briefly
Are premises occupied by any unrelated individuals? Describe briefly
Details of any business use of the premise: Describe briefly
Details of any cancellations or non-renewals in the past 5 years: Describe briefly
Details of all property insurance claims in the past 5 years: Describe briefly
If not how far to the nearest firehall?
Yes
No
Is property hydrant protected?
Type of Dwelling:
Amount of Dwelling Coverage Required:
Effective Date of Coverage:
Date of Birth:
(Work)
Name:
Address:
Over
40
years in business serving all of eastern Ontario and west Quebec
Phone Number: (Home)
Single Family
Semi-Detached
Row House/Townhouse- (inside/outside)
Commercial Building
Non Smoker