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Location / Applicant Information:
*
Indicates required field
Contact name
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Contact email
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Contact telephone number(s)
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What type of insurance do you require?
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Homeowners
Condominium
Tenant
What is your postal code?
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What city or town is the residence located in?
*
How far is your residence from the nearest fire hydrant?
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Within 1000 feet (300m)
Over 1000 feet (300m)
How far is the residence from the nearest fire hall?
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Within 5 miles (8 km)
Unprotected
Years at your current address?
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How many years have you had residential insurance?
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How many claims have you had in the past 10 years?
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None
1
2
3
More than 3
What is your age?
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Under 50
50-55
56-60
61-65
over 65
Prefer not to say
Dwelling Structure Information:
Select the structure type of the dwelling.
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Detached
Townhouse
Apartment building
Year dwelling was built?
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YYYY
Primary heating source?
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Central furnace - gas
Central furnace - oil
Electric
Hot water
Burglar alarm?
*
None
Local
Monitored
Coverage Information:
Enter the amount of insurance required for your home.
*
Enter the current replacement cost of the dwelling in Canadian dollars. This is not the market value; it is the cost to fully reconstruct the dwelling. This includes, but is not limited to, the cost of materials, labour and debris removal.
Enter the amount of insurance required for your contents.
*
Coverage options
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$2 million liability ($1 million included)
Sewer backup
Earthquake coverage
Overland water
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