Insurance for Every Need Home Owner Insurance Vancouver

Home Owner (detached house) insurance quote (based on declared building cost) request form

  • Available to residents or risk in BC and Ontario 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
* 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
2. Applicant’s Name, Date of Birth, Occupation (Age discount may apply)
First Name *
Last Name *
Date of Birth * Date Month Year
Occupation *
3. Co-Applicant’s (Spouse’s or Partner’s) Name, Date of Birth, Occupation (Age discount may apply)
First Name
Last Name
Date of Birth Date Month Year
Occupation
Relationship to Applicant
4. Address (Risk Location) and Date moved in
Street No *
Street Name *
City Name *
Postal Code *
Telephone Number *
E-mail Address *
Confirm E-mail Address *
Moved in on * Date Month Year
5. Past Unreported Claim (Fire, Theft, Water Damage etc)
a) * None
b) * Yes. If Yes, What happened, When, Where, Damaged amount
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
7. Previous (Current) Insurance
a) * None. If No, specify the reason why you are looking for one now.
b) * Yes. If Yes, specify Insurer's name, Policy Number, Expiry Date and Total Year Insured.
c) * Previously cancelled, declined or refused to renew by any insurer. If Yes, Why?
8. Year that Building was built (ex. 2005)
*
9. Number of mortgage?
* 0, 1, 2 or 3
10. Building’s Construction
* Frame (wood)
* Fire Resistive (concrete or stone)
* Other (Please specify below)
11. Primary Heating System (Central furnace- Gas, Oil, Propane, Electric, Gas-Hot water, Heat pump or etc. all details )
12. Auxiliary Heating System (Wood burning stove, wood or gas burning fire place or etc. all details )
13. Living space (furnished area of all levels)
* Sq.
14. Security in the House
Sprinkler
Local Alarm (Burglar and/or Fire)
Monitored Alarm (Burglar and/or Fire): Contract between you and a security company
15. Amount of insurance required for you home(detached house): Enter current replacement cost - Detailed building information is required for a final/adjusted quote.
* $
16. Optional coverage
Earthquake
Sewer backup
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
18. Other information such as additional protection for bicycles, fine arts, furs, golf clubs, jewellery or non-professional musical instruments.
Preview and
Confirm
Clear
All the data