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Home Owner (detached house) insurance quote (based on declared building cost) request form |
- Available to residents or risk in British Columbia only
- Please try to fill out all columns as detailed as possible. You may save more on your insurance premium.
- We will reply to you by e-mail or telephone within 1 or 2 business day(s).
- Privacy Policy
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| * Mandatory Field |
| 1. Type of Policy |
| * |
a) Home owner (detached) – Owner occupied |
| * | b) Home owner(detached) – Rent to Others |
| * | c) Home owner(detached) – Seasonal use |
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| 2. Applicant’s Name, Date of Birth, Occupation (Age discount may apply) |
| First Name * |
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| Last Name * |
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| Date of Birth * |
Date
Month
Year
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| Occupation * |
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| 3. Co-Applicant’s (Spouse’s or Partner’s) Name, Date of Birth, Occupation (Age discount may apply) |
| First Name |
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| Last Name |
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| Date of Birth |
Date
Month
Year
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| Occupation | |
| Relationship to Applicant | |
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| 4. Address (Risk Location) and Date moved in |
| Street No * |
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| Street Name * |
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| City Name * |
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| Postal Code * |
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| Telephone Number * |
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| E-mail Address * |
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| Confirm E-mail Address * |
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| Moved in on * |
Date
Month
Year
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| 5. Past Unreported Claim (Fire, Theft, Water Damage etc) |
| a) * |
None |
| b) * |
Yes. If Yes, What happened, When, Where, Damaged amount
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| 6. Past Reported Claim and Details in the past 10 years. |
a) * |
None |
| b) * |
Yes. If Yes, What happened, When, Where, Claimed amount, Status of the claim
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| 7. Previous (Current) Insurance |
| a) * |
None. If No, specify the reason why you are looking for one now.
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| b) * |
Yes. If Yes, specify Insurer's name, Policy Number, Expiry Date and Total Year Insured.
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| c) * |
Previously cancelled, declined or refused to renew by any insurer. If Yes, Why?
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| 8. Year that Building was built (ex. 2005) |
| * | |
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| 9. Number of mortgage? |
| * |
0, 1, 2 or 3
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| 10. Building’s Construction |
| * | Frame (wood) |
| * | Fire Resistive (concrete or stone) |
| * |
Other (Please specify below)
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| 11. Primary Heating System (Central furnace- Gas, Oil, Propane, Electric, Gas-Hot water, Heat pump or etc. all details ) |
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| 12. Auxiliary Heating System (Wood burning stove, wood or gas burning fire place or etc. all details ) |
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| 13. Living space (furnished area of all levels) |
| * |
Sq. |
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| 14. Security in the House |
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Sprinkler |
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Local Alarm (Burglar and/or Fire) |
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Monitored Alarm (Burglar and/or Fire): Contract between you and a security company |
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| 15. Amount of insurance required for you home(detached house): Enter current replacement cost - Detailed building information is required for a final/adjusted quote. |
| * |
$
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| 16. Optional coverage |
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Earthquake |
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Sewer backup |
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| 17. Additional Liability Exposure Information |
| Additional Families * |
Yes How many?
No |
| Rooms Rented to Others* |
Yes How many boarders?
No |
| Incidental Office Use * |
Yes How often?
No |
| Business Operations at this Location * |
Yes What kind of operation?
No |
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| 18. Other information such as additional protection for bicycles, fine arts, furs, golf clubs, jewellery or non-professional musical instruments. |
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