Quote Worksheet

Type of Policy

Will this property be used as a Rental?

Yes
No

Indicate for short term (e.g Airbnb) or long term rentals.

Applicant Details

Name

First

Last

Address

City

Province

Postal Code

Cell Phone

Other Phone

Specify Type

Email

Date of Birth

Occupation

Soft Credit Check?

I give authorization for a Soft Credit Check

How did you hear about us?

Second Applicant

Add a Second Applicant

Add a Second Applicant

Prior Insurance

Do you have prior Insurance?

Yes
No

How long have you lived at your current address?

Has your insurance ever been canceled, declined or refused?

Yes
No

State All Claims or Losses in the Past 5 Years

Even if you were not carrying insurance at the time, please provide the Date, Cause, and Amount of any losses in the past 5 years.

Miscellaneous

Is the Property a New Purchase?

Yes
No

Vacancy

Is the property Vacant?

Yes
No

Renovations

Renovations?

Yes
No

Occupancy

Commercial Occupancy?

Yes
No

Home Based Business?

Yes
No

Roommate / Home-stay Student

Yes
No

Does the Tenant Operate a Home-based business?

Yes
No

Cannabis

Are you Growing Cannabis?

Yes
No

Glass Policy

Would you like a separate Glass policy?

Property Description

Type of Building

Number of Stories

Number of Bathrooms

Indicate if the property has:

A Swimming Pool
A Basement

Construction

Year Built

Indicate Construction:

Frame
Fire Resistive
Log Home

Roof

% Ashphalt/fiberglass shingles

% Other (note details)

Age of Roof

Roof Notes

Electrical

Amp Service:

Electrical Panel:

Wiring % Copper

Wiring % Aluminum

Wiring % Knob & Tube

Year Electrical Updated

Electrical Wiring Notes

Plumbing

Plumbing % Copper

Plumbing % Galvanized Steel

Plumbing % Cast Iron

Plumbing % ABS Plastic

Plumbing % Poly B

Plumbing % PEX

Year Plumbing Updated

Plumbing Notes

Heating

Primary Type of Heating

Is the Heating Serviced Annually?

Yes
No

Year Heating Updated

Age of Hot Water Tank

Is there an Oil Tank on the property?

Yes
No

Is there a decommissioned Oil Tank on the property?

Yes
No

Do you have Auxiliary Heating?

Yes
No

This does not apply to fireplaces

Fire Protection

Type of Policy

Short Term Rental

Long Term Rental

Seasonal Occupancy