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What happened to your previous Auto Insurance Policy?
I, cancelled it
Cancelled by Insurance company for Non-Payment
Cancelled by Insurance company for Misrepresentation
When is did you cancelled your of your Auto Insurance Policy?
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Year
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How many Non-payments you have in past three years?
One
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When was the FIRST time your policy cancelled for Non-payment?
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January
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Month
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1
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1932
1931
1930
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1928
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1922
1921
1920
Year
When was the SECOND time your policy cancelled for Non-payment?
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January
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Month
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1
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31
Day
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1932
1931
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1929
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1921
1920
Year
When was the THIRD time your policy cancelled for Non-payment?
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Month
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1951
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1948
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
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When was your policy cancelled for Misrepresentation?
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January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
2
3
4
5
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31
Day
Please select a year
2024
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2020
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2015
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2013
2012
2011
2010
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1990
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1920
Year
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Marital Status
*
Please Select
Single
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Divorced
Does your Spouse have Driver's License
Yes
No
How many children you have with Valid Canadian Driver's License, Please select NONE if you do not have children you have with Valid Canadian Driver's License?
One
Two
Three
NONE
Do you have any other drivers in household?
Yes
No
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Your Information
Birth Date
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1971
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1969
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1966
1965
1964
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1962
1961
1960
Year
What is your occupation?
What kind of Driver's License you have?
*
Please Select
G
G2
G Driver's License Date
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1920
Year
G2 Driver's License Date
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Month
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1
2
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G1 Driver's License Date
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January
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March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
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Day
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1933
1932
1931
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1929
1928
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1926
1925
1924
1923
1922
1921
1920
Year
Please take a Photo of your Driver's License
*
Your Driver's License Number
*
Do you have Driver's Training Certificate?
Yes
No
Date of your Driver's Training Certificate
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
2
3
4
5
6
7
8
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31
Day
Please select a year
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2004
2003
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2000
1999
1998
1997
1996
1995
1994
1993
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1991
1990
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1981
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1972
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1970
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1953
1952
1951
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1949
1948
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1945
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1941
1940
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload photo of Driver's training Certificate
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Do you have any tickets, convictions or suspension?
*
Yes
No
Please specify type of tickets,convictions or suspensions with date?
Do you have any At-Fault claims in past six years?
*
Yes
No
Please mention Date of At-fault claims and type of claim?
Do you have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
*
Yes
No
Please mention Date of Not At-fault claims and type of claim?
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Spouse Information
Name of the Spouse
*
First Name
Last Name
Phone Number of Spouse
*
Email ID of Spouse
*
example@example.com
Birth Date of Spouse
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
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10
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12
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14
15
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17
18
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20
21
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28
29
30
31
Day
Please select a year
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
Year
What kind of Driver's License your spouse have?
*
Please Select
G
G2
G1
G Driver's License Date of spouse
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
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31
Day
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1939
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1935
1934
1933
1932
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1930
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1920
Year
G2 Driver's License Date of spouse
Please select a month
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February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
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Day
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2000
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1998
1997
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1991
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1986
1985
1984
1983
1982
1981
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1979
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1973
1972
1971
1970
1969
1968
1967
1966
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1964
1963
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1952
1951
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1945
1944
1943
1942
1941
1940
1939
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1937
1936
1935
1934
1933
1932
1931
1930
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1920
Year
G1 Driver's License Date of spouse
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
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19
20
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31
Day
Please select a year
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2010
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2008
2007
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
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1952
1951
1950
1949
1948
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1945
1944
1943
1942
1941
1940
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1936
1935
1934
1933
1932
1931
1930
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1920
Year
Please upload Photo of your Spouse Driver's License
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Your Spouse Driver's License Number
*
Does your spouse have Driver's Training Certificate?
Yes
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Date of your Spouse Driver's Training Certificate
*
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January
February
March
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May
June
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September
October
November
December
Month
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1
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8
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Day
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2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
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1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
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1920
Year
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Does your spouse have any tickets, convictions or suspension?
*
Yes
No
For your spouse: Please specify type of tickets,convictions or suspensions with date?
Does your Spouse have any At-Fault claims in past six years?
*
Yes
No
For your Spouse: Please mention Date of At-fault claims and type of claim?
Does your spouse have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
*
Yes
No
For your Spouse: Please mention Date of Not At-fault claims and type of claim?
Back
Next
Child - 1 Information
Name of the Child -1
*
First Name
Last Name
Email ID of Child - 1
*
example@example.com
Birth Date : Child -1
*
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January
February
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Month
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1
2
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31
Day
Please select a year
2010
2009
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2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
What kind of Driver's License Child - 1 have?
*
Please Select
G
G2
G1
G Driver's License Date of Child - 1
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
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8
9
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11
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2000
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1996
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1990
1989
1988
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1986
1985
1984
1983
1982
1981
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1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
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1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
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1925
1924
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1922
1921
1920
Year
G2 Driver's License Date of Child -1
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
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Day
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2002
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2000
1999
1998
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1996
1995
1994
1993
1992
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1988
1987
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1985
1984
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1982
1981
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1978
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1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
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1926
1925
1924
1923
1922
1921
1920
Year
G1 Driver's License Date of Child -1
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
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31
Day
Please select a year
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2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
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1925
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1923
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1921
1920
Year
Please upload Photo of Driver's License for Child -1
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Driver's License Number for Child - 1
*
Does Child - 1 have Driver's Training Certificate?
Yes
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Date of Driver's Training Certificate for Child- 1
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January
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March
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May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
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31
Day
Please select a year
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2015
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2011
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2007
2006
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
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1926
1925
1924
1923
1922
1921
1920
Year
Please upload photo of Driver's Training Certificate for Child - 1
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Does Child -1 have any tickets, convictions or suspensions?
Yes
No
For Child - 1 : Please specify type of tickets,convictions or suspensions with date?
Does your Child-1 have any At-Fault claims in past six years?
Yes
No
For your Child-1: Please mention Date of At-fault claims and type of claim?
Does your Child-1 have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
Yes
No
For your Child-1: Please mention Date of Not At-fault claims and type of claim?
Back
Next
Child - 2 Information
Name of the Child -2
*
First Name
Last Name
Email ID of Child - 2
*
example@example.com
Birth Date : Child -2
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
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18
19
20
21
22
23
24
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26
27
28
29
30
31
Day
Please select a year
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
What kind of Driver's License your Child - 2 have?
*
Please Select
G
G2
G1
G Driver's License Date of Child - 2
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
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20
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23
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31
Day
Please select a year
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G2 Driver's License Date of Child -2
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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19
20
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23
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30
31
Day
Please select a year
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2007
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G1 Driver's License Date of Child -2
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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28
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30
31
Day
Please select a year
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2014
2013
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2007
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload Photo of Driver's License for Child -2
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Driver's License Number for Child - 2
Does Child - 2 have Driver's Training Certificate?
Yes
No
Date of Driver's Training Certificate for Child- 2
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January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
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27
28
29
30
31
Day
Please select a year
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2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload photo of Driver's Training Certificate for Child - 2
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Does Child -2 have any tickets, convictions or suspensions?
Yes
No
For Child - 2 : Please specify type of tickets,convictions or suspensions with date?
Does your Child-2 have any At-Fault claims in past six years?
Yes
No
For your Child-2: Please mention Date of At-fault claims and type of claim?
Does your Child-2 have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
Yes
No
For your Child-2 : Please mention Date of Not At-fault claims and type of claim?
Back
Next
Child - 3 Information
Name of the Child -3
*
First Name
Last Name
Email ID of Child - 3
*
example@example.com
Birth Date: Child -3
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
What kind of Driver's License your Child - 3 have?
*
Please Select
G
G2
G1
G Driver's License Date of Child - 3
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
29
30
31
Day
Please select a year
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2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G2 Driver's License Date of Child -3
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
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12
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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1932
1931
1930
1929
1928
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1925
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1923
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1921
1920
Year
G1 Driver's License Date of Child -3
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload Photo of Driver's License for Child -3
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Driver's License Number for Child - 3
Does Child - 3 have Driver's Training Certificate?
Yes
No
Date of Driver's Training Certificate for Child- 3
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2001
2000
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1994
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload photo of Driver's Training Certificate for Child - 3
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Does Child -3 have any tickets, convictions or suspensions?
Yes
No
For Child - 3 : Please specify type of tickets,convictions or suspensions with date?
Does your Child-3 have any At-Fault claims in past six years?
Yes
No
For your Child-3: Please mention Date of At-fault claims and type of claim?
Does your Child-3 have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
Yes
No
For your Child-3: Please mention Date of Not At-fault claims and type of claim?
Back
Next
Information about other Driver in the household
Name of the other Driver in the household
First Name
Last Name
Email ID of other Driver
example@example.com
Birth Date: Other Driver in the household
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
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11
12
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15
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20
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30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
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1999
1998
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
What kind of Driver's License other Driver have?
Please Select
G
G2
G1
G Driver's License Date of other Driver in the household
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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28
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30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
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2000
1999
1998
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G2 Driver's License Date of other Driver in the household
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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20
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30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
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1988
1987
1986
1985
1984
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1982
1981
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1979
1978
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1972
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1952
1951
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1948
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1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
G1 Driver's License Date of other Driver in the household
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
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1978
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1948
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1941
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload Photo of Driver's License for other Driver in the household
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Driver's License Number for other Driver in the household
Does other Driver in the household have Driver's Training Certificate?
Yes
No
Date of Driver's Training Certificate for other Driver in the household
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
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1959
1958
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1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please upload photo of Driver's Training Certificate for other Driver in the household
Browse Files
Drag and drop files here
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Cancel
of
Does other Driver in the household have any tickets, convictions or suspension?
Yes
No
For for other Driver in the household : Please specify type of tickets,convictions or suspensions with date?
Does other Driver in household have any At-Fault claims in past six years?
Yes
No
For other Driver in household: Please mention Date of At-fault claims and type of claim?
Does other Driver in household have any Not At-Fault claims in past six years? (including Fire, theft, vandalism, glass breakage)
Yes
No
For other Driver in household: Please mention Date of Not At-fault claims and type of claim?
Back
Next
How many Vehicles you have?
*
One
Two
Three
Back
Next
Vehicle - 1 Information Sheet
Vehicle 1
*
Vehicle - 1 What kind of Vehicle is this?
Brand New
Used
Vehicle - 1 Please upload the bill of sale for Brand New Vehicle
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Vehicle - 1 Please upload the photo of ownership
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I have purchased this vehicle- 1 on
My Personal Name
Under the Name of my corporation
Vehicle 1 - Date of Purchase
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
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1958
1957
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1955
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1953
1952
1951
1950
1949
1948
1947
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1945
1944
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1941
1940
1939
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Type of purchase or ownership for Vehicle - 1
Purchased for Cash
Financed
Leased
Vehicle -1 Purchase Price
Amount in Canadian Dollars
What kind of coverage you want for Vehicle 1?
Third Party
Full Coverage
Please tell me price with both the options
Lien Holder or Loan Provider (Name and Address) Vehicle 1
Lease Provider (Name and Address) - Vehicle 1
Daily Commute to work in Kilometers for Vehicle - 1
Annual kilometers for Vehicle - 1
Do you have winter tires for Vehicle - 1 ?
Yes
No
Please upload photo of winter tires or bill for winter tires (Vehicle -1)
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Please upload Article of Incorporation (Vehicle -1)
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Back
Next
Vehicle - 2 Information Sheet
Vehicle 2
*
Vehicle - 2 What kind of Vehicle is this?
Brand New
Used
Please upload the bill of sale for Brand New Vehicle
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Cancel
of
Please upload the photo of ownership
Browse Files
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I have purchased this vehicle- 2 on
My Personal Name
Under the Name of my corporation
Vehicle 2 - Date of Purchase
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
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1959
1958
1957
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1952
1951
1950
1949
1948
1947
1946
1945
1944
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1941
1940
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Type of purchase or ownership for Vehicle - 2
Purchased for Cash
Financed
Leased
Vehicle -2 Purchase Price
Amount in Canadian Dollars
What kind of coverage you want for Vehicle 2?
Third Party
Full Coverage
Please tell me price with both the options
Lien Holder or Loan Provider (Name and Address) Vehicle 2
Lease Provider (Name and Address) - Vehicle 2
Daily Commute to work in Kilometers for Vehicle - 2
Annual kilometers for Vehicle - 2
Do you have winter tires for Vehicle - 2
Yes
No
Please upload photo of winter tires or bill for winter tires (Vehicle -2)
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Please upload Article of Incorporation for Vehicle -2
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Back
Next
Any other Vehicle- Information Sheet
Do you have any other Vehicle in Household?
ATV
Motorcycle
Snow Vehicle
None
Vehicle 3
What kind of Vehicle is this?
Brand New
Used
Please upload the bill of sale for Brand New Vehicle - 3
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Please upload the photo of ownership for Vehicle - 3
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I have purchased this vehicle -3 on
My Personal Name
Under the Name of my corporation
Vehicle 3 - Date of Purchase
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Type of purchase or ownership for Vehicle - 3
Cash purchased
Financed
Leased
Vehicle -3 Purchase Price
Amount in Canadian Dollars
What kind of coverage you want for Vehicle 3?
Third Party
Full Coverage
Please tell me price with both the options
Lien Holder or Loan Provider (Name and Address) Vehicle 3
Lease Provider (Name and Address) - Vehicle 3
Daily Commute to work in Kilometers for Vehicle - 3
Annual kilometers for Vehicle - 3
Do you have winter tires for Vehicle - 3
Yes
No
Please upload photo of winter tires or bill for winter tires (Vehicle -3)
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Please upload Article of Incorporation for Vehicle -3
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Back
Next
Are you?
*
Homeowner
Tenant (Living on RENT)
Would you like a quote for your Property Insurance, it's can cover your risk and it can also help you in getting additional discount on your Auto Insurance?
*
Yes
No
Back
Next
Property Insurance Information
Is this your primary residence
Yes
No, it's Investment Property and I have a different address
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Purchase Price ($)
Example - 800K
Down-payment Amount ($)
Example - 100K
Mortgage Provider (Name and Address)
Back
Next
Signature
*
Apply for quote
Should be Empty: