Request an Insurance Quote
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Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Quote Requested
*
Please Select
Personal Auto Insurance
Personal Property Insurance
Fishing Vessel Insurance
Yacht Insurance
Commercial Auto Insurance
Commercial Property Insurance
Life Insurance
Other
Personal Vehicle Details
*
Rows
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Year
Make
Model
VIN
Annual kms
Commute kms (One Way)
Winter Tires During Winter Season
Commercial Vehicle Details
*
Rows
Year
Make
Model
Annual Km
Radius of Operations
Veh 1
Veh 2
Veh 3
Veh 4
Details of Vehicle/Business Use
Liability Requested
*
Rows
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
1 Million Liability
2 Million Liability
Collision Coverage Requested
*
Rows
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
No Collision
Collision with $500 Deductible
Collision with $1000 Deductible
Comprehensive Coverage Requested
*
Rows
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
No Comprehensive
Comprehensive with $250 Deductible
Comprehensive with $500 Deductible
Comprehensive with $1000 Deductible
Driver Details
*
Rows
Driver 1
Driver 2
Driver 3
Driver 4
Full Name
Date of Birth (dd/mm/yyyy)
Date Licensed (dd/mm/yyyy)
Driver's License Number
Has any driver completed a Driver Training Course?
*
Yes
No
Has any driver had any previous Canadian Driver's License?
*
Yes
No
If yes, please provide Province, Driver's License #, Date Obtained (Driver's Abstract will be Required)
Has any driver had any previous Driver's License from Outside Canada?
*
Yes
No
If yes, please provide Country and Date Obtained (Photo will be required)
Has any driver had any accidents or claims in the last 6 years?
*
Yes
No
If yes please provide date, driver and details of each claim
Has any driver had any tickets or convictions in the last 6 years?
*
Yes
No
If yes please provide the driver name, date and details of each conviction.
Has any driver had their Driver's License suspended in the last 6 years?
*
Yes
No
Has any driver been convicted of insurance fraud in the last 6 years?
*
Yes
No
Nova Scotia & New Brunswick Only: Do you provide permission to run a soft credit check which can help reduce your insurance premium? This will not show as a hit on your credit report.
Yes
No
Details of Vessel
Rows
Name
Year Built
Material
Length
Open or Decked?
GRT
Heating/Cooking Fuel Type
Vessel 1
Vessel 2
Details of Yacht
Rows
Year Built
Manufacturer
Model
Length
Material
Value
Yacht 1
Yacht 2
Type of Boat
Please Select
Bass Boat
Cruiser
Jet Boat
Pontoon
PWC
Runabout
Sailboat
Skiboat
Other
Type of Motor
Please Select
Outboard Motor
Inboard Motor
Inboard/Outboard Motor
Jet Drive Motor
Estimated Maximum Speed (MPH)
Engine Details
Rows
Year
Make
Model
Fuel
Main Engine
Auxiliary Engine 1
Auxiliary Engine 2
Yacht Motor / Tender / Trailer Details
Rows
Year
Manufacturer
Horse Power/Length
Fuel
Value
Main Motor
Auxillery Motor 1
Auxillery Motor 2
Trailer
Tender
Operations
Rows
Type of Fishing
Area
Home Port
Number of Crew
Vessel 1
Vessel 2
Value of Vessel
Rows
Replacement Cost
Market Value
Purchase Price
Vessel 1
Vessel 2
Have you had any marine claims in the last 5 years? If Yes, provide details below.
Yes
No
Details of Prior Claims
Waters Navigated
Please Select
Coastal
Inland
Both Coastal and Inland
Area of Use
House Details
Rows
Year Built
Type of Home ie/ Bungalow, 1-1/2 Storey
Above Ground Square Footage
Location 1
Location 2
Year of Last Updates
Rows
Fully Updated
Partially Updated
Year of Update?
Heating
Plumbing
Electrical
Roof
Type of Primary Heating
Electric
Oil Furnace
Wood Furnace
Combination Oil/Wood Furnace
Other
Type of Auxiliary Heating
Wood Burning Unit
Propane
None
Other
Type of Siding
Vinyl
Wood
Cedar Shingles
Other
Type of Roof
Ashphalt Shingles
Metal
Tar and Gravel
Other
What type of insurance are you looking for?
*
***Further Information May Be Required to Complete the Quote***
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