Property Quote Form - Service "*" indicates required fields What type of property would you like quoted?*Make sure to select the proper type of quote. Homeowner'sCondominiumTenant'sWho is your broker?*Please select your broker. If you are unsure of who your broker is, select the person who sent you this form.Select BrokerArlinda LopesDebra WellsJaidra Mt. PleasantJean LyJoshua PrimeauKayla WeirmeirLinda GallucciVictoria MernerUnsure HOMEOWNER'S ON TITLEPlease complete details for every person who's name is on title as owner of the property. Must be completed for an accurate quote.How many people's names are on title as owners of the property?*1234Name* First Name Last Name Phone Number*Optional Secondary Phone NumberEmail* Optional Secondary Email Date of Birth* MM slash DD slash YYYY Gender*SelectMaleFemalePrefer Not To SayCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible.Desired Effective Date*What day would you like the insurance to begin? MM slash DD slash YYYY CONDOMINIUM OWNER'S ON TITLEPlease complete details for every person who's name is on title as owner of the condominium. Must be completed for an accurate quote.How many people's names are on title as owners of the property?*1234Name* First Name Last Name Phone Number*Optional Secondary Phone NumberEmail* Optional Secondary Email Date of Birth* MM slash DD slash YYYY Gender*selectMaleFemalePrefer Not To SayCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible.Desired Effective Date*What day would you like the insurance to begin? MM slash DD slash YYYY TENANT'S ON RENTAL AGREEMENTPlease complete details for every person who's name is on the rental agreement. Must be completed for an accurate quote.How many people's names are on the rental agreement as renter's?*1234Name* First Name Last Name Phone Number*Optional Secondary Phone NumberEmail* Optional Secondary Email Date of Birth* MM slash DD slash YYYY Gender*SelectMaleFemalePrefer Not To SayCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible.Desired Effective Date*What day would you like the insurance to begin? MM slash DD slash YYYY Second Applicant's Details2nd Name on title* First Name Last Name Date of Birth* MM slash DD slash YYYY Gender*MaleFemaleCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible. Third Applicant's Details3rd Name on title* First Name Last Name Date of Birth* MM slash DD slash YYYY Gender*MaleFemaleCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible. Fourth Applicant's Details4th Name on title* First Name Last Name Date of Birth* MM slash DD slash YYYY Gender*MaleFemaleCurrent Occupation*Certain occupations qualify for preferred rates, be as detailed as possible. Location DetailsUse of the property?*How is the property going to be inhabited, this is important for the proper coverage to be applied to your quote.My primary residenceIncome Rental Property - No StudentsIncome Rental Property - Student RentalMy secondary residence - Not a CottageSeasonal PropertyVacantBuilders Risk - Complete New BuildBuilders Risk - Existing Structure RenovationShort Term Rentals -Air BNBUnsure / Other (Leave Remarks at End)Property Address*Please mention if there is a unit number. Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code*Mailing Address*Please mention if there is a unit number. Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Mailing Postal Code*Postal Code for Mailing AddressDistance To Nearest Fire Hydrant*Within 150 metresWithin 300 metresOver 300 metresUnprotectedUnsureDistance To Nearest Firehall*Within 5 KM'sWithin 8 KM'sOver 8 KM'sUnprotectedUnsureBusiness in the home?*Is there any business activity in the home?NoYesDescribe business in the home.*Please describe the business in the home. Be as detailed as possible about the business. Property DetailsHow many storeys?*This does NOT include the basement.Bungalow1-1/2 Storeys2 Storeys2-1/2 Storeys3 Storeys3-1/2 Storeys4 StoreysWhat type of property will you be renting?*If inside a building select High-rise Apartment. If inside a home the basement does NOT count as a storey.High-rise ApartmentBungalow1-1/2 Storeys Home2 Storeys Home2-1/2 Storeys Home3 Storeys Home3-1/2 Storeys HomeTerrace HomeUnsure/Other (Leave Remarks at End)Type of structure?*DetachedSemi-DetachedTown House in RowTown House End UnitTerrace HomeDuplexTriplexUnsure/Other (Leave Remarks at End)How many storeys?*If condo is in a high-rise building select high-rise. The basement is NOT included as a storey.Bungalow1-1/2 Storeys2 Storeys2-1/2 Storeys3 Storeys3-1/2 Storeys4 StoreysHigh-rise buildingEstimated square footage?This only includes main level and upstairs. Basement square footage is excluded from this calculation.Unsure500 Square Feet550 Square Feet600 Square Feet650 Square Feet700 Square Feet750 Square Feet800 Square Feet850 Square Feet900 Square Feet950 Square Feet1,000 Square Feet1,100 Square Feet1,200 Square Feet1,300 Square Feet1,400 Square Feet1,500 Square Feet1,600 Square Feet1,700 Square Feet1,800 Square Feet1,900 Square Feet2,000 Square Feet2,100 Square Feet2,200 Square Feet2,300 Square Feet2,400 Square Feet2,500 Square Feet2,600 Square Feet2,700 Square Feet2,800 Square Feet2,900 Square Feet3,000 Square Feet3,100 Square Feet3,200 Square Feet3,300 Square Feet3,400 Square Feet3,500 Square Feet3,600 Square Feet3,700 Square Feet3,800 Square Feet3,900 Square Feet4,000 Square Feet4,100 Square Feet4,200 Square Feet4,300 Square Feet4,400 Square Feet4,500 Square Feet4,600 Square Feet4,700 Square Feet4,800 Square Feet4,900 Square Feet5,000 Square Feet +How many bathrooms?*1 Full Bathroom1 Full Bathroom / 1 Half Bathroom1 Full Bathroom / 2 Half Bathrooms2 Full Bathrooms2 Full Bathrooms / 1 Half Bathroom2 Full Bathrooms / 2 Half Bathrooms2 Full Bathrooms / 3 Half Bathooms3 Full Bathrooms3 Full Bathrooms / 1 Half Bathroom3 Full Bathrooms / 2 Half Bathrooms3 Full Bathrooms / 3 Half Bathrooms4 Full Bathrooms4 Full Bathrooms / 1 Half Bathroom4 Full Bathrooms / 2 Half Bathrooms4 Full Bathrooms / 3 Half Bathrooms4 Full Bathrooms / 4 Half Bathrooms5 Full BathoomsHow many kitchens?*1 Kitchen2 Kitchens3 Kitchens4 KitchensHow many bedrooms?*1 Bedroom2 Bedrooms3 Bedrooms4 Bedrooms5 Bedrooms6 Bedrooms +Finished basement?*100% Finished75% Finished66% Finished50% Finished33% Finished25% FinishedBasement is unfinishedNo BasementUnsureType of Siding?*Which type of siding is the majority of the exterior?AluminumBrickCedar SidingCementLogMetalStoneStuccoVinylWoodUnsureWhich type of garage?*1. Attached = Attached to the house but no room above 2. Built-In = Has a room above the garage 3. Basement = Below grade, level with basement NoneAttached 1 Car GarageAttached 2 Car GarageAttached 3 Car GarageBuilt-In 1 Car GarageBuilt-In 2 Car GarageBuilt-In 3 Car GarageBasement 1 Car GarageBasement 2 Car GarageBasement 3 Car GarageCarportUnsureIs there a swimming pool?*Does not include hot tub or sauna.NoneIn Ground ConcreteIn Ground FiberglassIn Ground VinylAbove Ground StandardAbove Ground FiberglassWhen was the pool installed?*Same Year as the HouseUnsure2030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970Prior to 1970Is the pool fenced in?*Is there a fence that surrounds the pool?YesNoNo, but there will be shortlyUnsureHow much content coverage will you require?*This is the amount of money you will require to replace your belongings if they were destroyed.$30,000$35,000$40,000$45,000$50,000$60,000$70,000$80,000$90,000$100,000 Dates DetailsWhich year was the building constructed?*Unsure20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Before 1900Possesion Date?*When did you or will you be taking possession of this property?Select hereEffective date of this policy.20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Electrical Update*When was the electrical last updated?Select hereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of electrical wiring?*Copper is the most up to date type of electrical wiring.AluminumCopperKnob & TubeMixUnknownHow many AMPS on the panel?*Can normally be found on the electrical panel. Most homes have 100 amps.60 AMPS100 AMPS200 AMPSUnsureType of electrical panel?*Breakers are the most up to date type of panel.BreakersFusesUnsurePlumbing Update*When was the plumbing last updated?Select hereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of plumbing?*Copper / ABS is the most up to date type of plumbing.UnsureCopper / ABSLeadCast IronPexPolybOtherSeptic or City Sewage?*Most homes in the city are on city sewage.City SewageUnsureSeptic No Sump PumpSeptic with Sump PumpSeptic with Sump Pump & Generator BackupSeptic with Sump Pump & Battery BackupOtherAge of Hot Water Tank?*When was the hot water tank last updated?UnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Roof Update*When was the roof last updated?Select hereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of roofing material?*Most peaked roofs have Asphalt Shingle. Most flat roofs have Tar & Gravel.UnsureAsphalt shinglesClay tileConcrete tileCorrugated steelElastomerMetal tileRubberSlate tileTar & gravelWood shakesWood shinglesOtherType of water heater?*Select hereStandardTanklessWater Heater Update*When was the heater last updated?Select hereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Primary Heating Update*When was the primary heating last updated?Select hereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of primary heating?*Most residential homes use a Natural Gas Furnace as primary source of heating.UnsureNatural Gas FurnaceOil FurnacePropane FurnaceWood FurnaceElectricHot Water/SteamCombination FurnaceSolid FuelGas Space HeaterOil Space HeaterElectric Space HeaterWood Burning StoveFireplaceFireplace InsertSolarHeat PumpOtherNoneIs there a secondary source of heat?*NoYes, wood fireplaceYes, natural gas fireplaceYes, propane fireplaceYes, woodstoveYes, electric baseboardsUnsure Dates DetailsWhich year was the house - or- building built?*Unsure20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Prior to 1900Possesion Date?*When did you or will you be taking possession of this property?Effective date of this policy.20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of primary heating?*Most residential homes use a Natural Gas Furnace as primary source of heating. Many high rises use Electric as primary source of heating.UnsureNatural Gas FurnaceElectricOil FurnacePropane FurnaceWood FurnaceHot Water/SteamCombination FurnaceSolid FuelGas Space HeaterOil Space HeaterElectric Space HeaterWood Burning StoveFireplaceFireplace InsertSolarHeat PumpOtherNone MortgageThis section will help us accurately process your request.Do you have a mortgage or loan?*Please let us know if you have a mortgage or loan so we can ensure your request is processed accurately.SelectYes, I have a mortgage.No, I don't have a mortgage.Mortgagee's Name*Please input below the name of the mortgagee, lienholder or lender.Mortgagee's Address*Please input the address of your mortgagee, lienholder or lender. Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code DiscountsThis section can offer substantial discounts to your quote.Smoker-Free Household Discount?*In order to be eligible no smoker can live at the house, even if they always smoke outside.Yes, smoke free household.Not a smoker free household.Mortgage Free Discount?*In order to be eligible the property must not have a mortgage, a line of credit is acceptable.Yes, property is mortgage free.No, this property has 1 mortgage.No, this property has 2 mortgages.No, this property has 3 mortgages.Alarm Discount?*In order to be eligible you must have an alarm that is monitored and be able to provide a certificate from the alarm company.No monitored alarmYes, fire and burlgar monitoredYes, just burglar monitoredYes, just fire monitoredCredit Consent Given? - soft credit check - (will not affect credit score)*“As your broker, I am gathering this consent on behalf of the insurer who advises me that: In respect of this quotation, we may collect, use and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law. Do you, and on behalf of others listed, authorize us to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, investigate and settle claims, analyze business results and detect and prevent fraud? “Yes - credit consent givenNo - credit consent deniedPicture & Document UploadOptional feature, upload pictures of any important documents, or features of the home, etc. Drop files here or Select files Max. file size: 50 MB. CommentsInclude any additional comments.EmailThis field is for validation purposes and should be left unchanged.
