Home & Tenant Insurance Quote Questionnaire

1
Please enter your full legal name
First Name
Last Name
2
Address you are insuring
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Your phone number
Area Code
Phone Number
4
Your birthdate
Date
Year
Month
Day
5
Your Occupation
6
Do you own or rent the property?
OwnerRenter
7
Have you had any property claims in the last 5 years?
YesNo
8
Do you consent to a soft credit check (wont affect your credit score, just helps with the price)
YESNO
9
Is location within 300 metres of a fire hydrant?
YesNo
10
Is location within 8 kilometres of a fire hall?
YESNO
11
Are you a first time home buyer? (if renter select "no")
YESNO
12
Smoke Free House hold?
YESNO
13
What would you like your deductible to be?Deductible is what you pay out before the insurance does (higher deductible lower premium)
1000
1500
2000
more than 2500
14
What liability limit would you like to have?This is what the insurance company will cover if you are being sued (1 million cheaper vs 2 million)
1 Million2 Million
15
Contents Coverage (for renters only)If you had to replace all the items in your unit how much would that cost (40,000 is minimum & standard)
16
When did you first get property Insurance?If no previous, leave blank
Date
Year
Month
Day
17
How long have you been with your current property Insurance provider If no previous leave blank
Date
Year
Month
Day
18
What is the building type?
Semi-detached
Detached
Row/Town House
Low Rise Apartment
High Rise Apartment
19
If an apartment, how many stories (total) and what floor are you on?
Huge
Large
Normal
Small
Ok
Ok
20
How many square feet is your living space?
21
When did you move in to this location?
Date
Year
Month
Day
22
When was the building built?
Date
Year
Month
Day
23
How many bathrooms?
24
Date electrical updatedIf unknown leave blank
Date
Year
Month
Day
25
How many Amp ServiceIf unknown click next
100
200
26
Date the plumbing was updatedIf unknown leave blank
Date
Year
Month
Day
27
Date the roof has been redone?If unknown leave blank
Date
Year
Month
Day
28
Date the heating has been redone?If unknown leave blank
Date
Year
Month
Day
29
Type of heatingPlease provide a description of the main heating source (i.e Gas Furnace) if there is a secondary heating source (i.e electric fireplace) please provide details
Huge
Large
Normal
Small
Ok
Ok
30
Do you have a burglar alarm installed
YesNo
31
Is the basement finished?
YESNO
32
Number of smoke detectors?
33
Number of fire extinguishers?
34
Do you have dead bolt locks on the doors?
YesNo
35
Do you have any additional items of high value you want added coverage for? If so, list items with associated value(i.e Jewellery, fine arts, collectibles)
Huge
Large
Normal
Small
Ok
Ok
36
Have you been cancelled for non-pay in the last 3 years?
YesNo
37
Do you have a mortgage? (homeowners only)If so provide address and name of lender
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: