Motorcycle Quote Form Registered Vehicle OwnerThis will be the policy owner and must be the registered owner of the motorcycle to be insured.Registered Vehicle Owner's Name* First Name Last Name Phone Number*Optional Secondary Phone NumberEmail* Optional Secondary Email Address*Address the vehicle is registered to. Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code* How did you hear about us?* Effective Date*Requested Policy Start Date MM slash DD slash YYYY Motorcycle #1 DetailsHow many motorcycles would you like quoted?*Only motorcycles, we have a separate form for private passenger automobiles.1234Year of Vehicle*202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Make & Model & CC's*Be as specific as possible for most accurate quote and mention how many CC's. VINProviding a VIN is not mandatory but will increase accuracy of the quote. Condition When Bought*What status was the vehicle when you purchased it?NewUsedDemoPurchase Price?*What was your cost to purchase the motorcycle?$500$1,000$1,500$2,000$2,500$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000$18,000$19,000$20,000$22,500$25,000$27,500$30,000$32,500$35,000$37,500$40,000$42,500$45,000$50,000$55,000$60,000 +Annual KM's Driven*How many KM's do you expect to put on the vehicle over the course of the next year?1,000 km/year2,000 km/year3,000 km/year4,000 km/year5,000 km/year7,500 km/year10.000 km/year12,500 km/year15,000 km/year17,500 km/year20,000 km/year25,000 km/year30,000 km/year35,000 km/year40,000 km/year45,000 km/year50,000 km/yearOver 50,000 km/yearIs vehicle currently financed or leased?*FinancedOwned outrightLeasedCoverage Required:If financed or leased full coverage is mandatory.Full CoverageComprehensive and LiabilityOne-way CoverageI'm not sureAny Pre-Existing Damage on the Vehicle?If any pre-existing damage please be as detailed as possible explaining the damage. No Damage Motorcycle #2 DetailsYear of Vehicle*20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Make & Model & CC's*Be as specific as possible for most accurate quote and mention how many CC's. VINProviding a VIN is not mandatory but will increase accuracy of the quote. Condition When Bought*What status was the vehicle when you purchased it?NewUsedDemoPurchase Price?*What was your cost to purchase the motorcycle?$500$1,000$1,500$2,000$2,500$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000$18,000$19,000$20,000$22,500$25,000$27,500$30,000$32,500$35,000$37,500$40,000$42,500$45,000$50,000$55,000$60,000 +Annual KM's Driven*How many KM's do you expect to put on the vehicle over the course of the next year?1,000 km/year2,000 km/year3,000 km/year4,000 km/year5,000 km/year7,500 km/year10.000 km/year12,500 km/year15,000 km/year17,500 km/year20,000 km/year25,000 km/year30,000 km/year35,000 km/year40,000 km/year45,000 km/year50,000 km/yearOver 50,000 km/yearIs vehicle currently financed or leased?*FinancedOwned outrightLeasedCoverage Required:If financed or leased full coverage is mandatory.Full CoverageComprehensive and LiabilityOne-way CoverageI'm not sureAny Pre-Existing Damage on the Vehicle?If any pre-existing damage please be as detailed as possible explaining the damage. No Damage Motorcycle #3 DetailsYear of Vehicle*20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Make & Model & CC's*Be as specific as possible for most accurate quote and mention how many CC's. VINProviding a VIN is not mandatory but will increase accuracy of the quote. Condition When Bought*What status was the vehicle when you purchased it?NewUsedDemoPurchase Price?*What was your cost to purchase the motorcycle?$500$1,000$1,500$2,000$2,500$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000$18,000$19,000$20,000$22,500$25,000$27,500$30,000$32,500$35,000$37,500$40,000$42,500$45,000$50,000$55,000$60,000 +Annual KM's Driven*How many KM's do you expect to put on the vehicle over the course of the next year?1,000 km/year2,000 km/year3,000 km/year4,000 km/year5,000 km/year7,500 km/year10.000 km/year12,500 km/year15,000 km/year17,500 km/year20,000 km/year25,000 km/year30,000 km/year35,000 km/year40,000 km/year45,000 km/year50,000 km/yearOver 50,000 km/yearIs vehicle currently financed or leased?*FinancedOwned outrightLeasedCoverage Required:If financed or leased full coverage is mandatory.Full CoverageComprehensive and LiabilityOne-way CoverageI'm not sureAny Pre-Existing Damage on the Vehicle?If any pre-existing damage please be as detailed as possible explaining the damage. No Damage Motorcycle #4 DetailsYear of Vehicle*20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Make & Model & CC's*Be as specific as possible for most accurate quote and mention how many CC's. VINProviding a VIN is not mandatory but will increase accuracy of the quote. Condition When Bought*What status was the vehicle when you purchased it?NewUsedDemoPurchase Price?*What was your cost to purchase the motorcycle?$500$1,000$1,500$2,000$2,500$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000$18,000$19,000$20,000$22,500$25,000$27,500$30,000$32,500$35,000$37,500$40,000$42,500$45,000$50,000$55,000$60,000 +Annual KM's Driven*How many KM's do you expect to put on the vehicle over the course of the next year?1,000 km/year2,000 km/year3,000 km/year4,000 km/year5,000 km/year7,500 km/year10.000 km/year12,500 km/year15,000 km/year17,500 km/year20,000 km/year25,000 km/year30,000 km/year35,000 km/year40,000 km/year45,000 km/year50,000 km/yearOver 50,000 km/yearIs vehicle currently financed or leased?*FinancedOwned outrightLeasedCoverage Required:If financed or leased full coverage is mandatory.Full CoverageComprehensive and LiabilityOne-way CoverageI'm not sureAny Pre-Existing Damage on the Vehicle?If any pre-existing damage please be as detailed as possible explaining the damage. No Damage Driver #1 DetailsIncluding yourself how many motorcycle riders in the household?*12345Driver # 1 Name* First Name Last Name Gender*MaleFemaleDriver # 1 Date of Birth* MM slash DD slash YYYY Driver # 1 Marital Status*SingleCommon-LawMarriedDivorcedWidowedDriver # 1 Occupation:Certain occupations qualify for preferred rates, be as detailed as possible. Driver # 1 Current License Held*None, this is a hypothetical quote.M1M2MOut of province licenseDriver # 1 Year License Issued*What year did you receive this license?202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 or earlierDriver # 1 Ontario Driver's License Number* Have you completed motorcycle driver training?*Yes, completed driver training.No, have not completed driver training.How many tickets in past 3 years?*Parking tickets don't count.012345Over 5How many accidents in past 6 years?*012345Over 5How many drivers license suspensions in past 3 years?*012Over 2How many cancellations by the insurance company in past 3 years for non-payment?*012Over 2 Driver #2 DetailsDriver # 2 Name* First Name Last Name Gender*MaleFemaleDriver # 2 Date of Birth* MM slash DD slash YYYY Driver # 2 Marital Status*SingleCommon-LawMarriedDivorcedWidowedDriver # 2 Occupation:Certain occupations qualify for preferred rates, be as detailed as possible. Driver # 2 Current License Held*None, this is a hypothetical quote.M1M2MOut of province licenseDriver # 2 Year License Issued*What year did you receive this license?202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 or earlierHave you completed motorcycle driver training?*Yes, completed driver training.No, have not completed driver training.Driver # 2 Ontario Driver's License Number* How many tickets in past 3 years?*Parking tickets don't count.012345Over 5How many accidents in past 6 years?*012345Over 5How many drivers license suspensions in past 3 years?*012Over 2How many cancellations by the insurance company in past 3 years for non-payment?*012Over 2 Driver #3 DetailsDriver # 3 Name* First Name Last Name Gender*MaleFemaleDriver # 3 Date of Birth* MM slash DD slash YYYY Driver # 3 Marital Status*SingleCommon-LawMarriedDivorcedWidowedDriver # 3 Occupation:Certain occupations qualify for preferred rates, be as detailed as possible. Driver # 3 Current License Held*None, this is a hypothetical quote.M1M2MOut of province licenseDriver # 3 Year License Issued*What year did you receive this license?202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 or earlierHave you completed motorcycle driver training?*Yes, completed driver training.No, have not completed driver training.Driver # 3 Ontario Driver's License Number* How many tickets in past 3 years?*Parking tickets don't count.012345Over 5How many accidents in past 6 years?*012345Over 5How many drivers license suspensions in past 3 years?*012Over 2How many cancellations by the insurance company in past 3 years for non-payment?*012Over 2 Driver #4 DetailsDriver # 4 Name* First Name Last Name Gender*MaleFemaleDriver # 4 Date of Birth* MM slash DD slash YYYY Driver # 4 Marital Status*SingleCommon-LawMarriedDivorcedWidowedDriver # 4 Occupation:Certain occupations qualify for preferred rates, be as detailed as possible. Driver # 4 Current License Held*None, this is a hypothetical quote.M1M2MOut of province licenseDriver # 4 Year Licesne Issued*What year did you receive this license?202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 or earlierHave you completed motorcycle driver training?*Yes, completed driver training.No, have not completed driver training.Driver # 4 Ontario Driver's License Number* How many tickets in past 3 years?*Parking tickets don't count.012345Over 5How many accidents in past 6 years?*012345Over 5How many drivers license suspensions in past 3 years?*012Over 2How many cancellations by the insurance company in past 3 years for non-payment?*012Over 2 Driver #5 DetailsDriver # 5 Name* First Name Last Name Gender*MaleFemaleDriver # 5 Date of Birth* MM slash DD slash YYYY Driver # 5 Marital Status*SingleCommon-LawMarriedDivorcedWidowedDriver # 5 Occupation:Certain occupations qualify for preferred rates, be as detailed as possible. Driver # 5 Current License Held*None, this is a hypothetical quote.M1M2MOut of province licenseDriver # 5 Year License Issued*What year did you receive the license?202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 or earlierHave you completed motorcycle driver training?*Yes, completed driver training.No, have not completed driver training.Driver # 5 Ontario Driver's License Number* How many tickets in past 3 years?*Parking tickets don't count.012345Over 5How many accidents in past 6 years?*012345Over 5How many drivers license suspensions in past 3 years?*012Over 2How many cancellations by the insurance company in past 3 years for non-payment?*012Over 2 Upload / CommentsPicture & Document UploadOptional feature, upload picture of vehicle, ownership, driver's license, etc. Drop files here or Select files Max. file size: 50 MB. CommentsInclude any additional comments.