What type of property would you like quoted?*Make sure to select the proper type of quote. Select HereHomeowner'sCondominiumTenant'sRental Income PropertyWho 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 HereArlinda LopesCody FaucherDonald AndersonJade BeamanJanae MalcolmKayla WeirmeirLinda GallucciVictoria MernerUnsureName of Title Holder* First Last Name of Additional Title Holder First Last Name on Lease* First Last Additional Names on LeasePlease separate the names with a comma.Full Address of the Property to be Insured* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date First Occupied or Closing Date Is there a Mortgage?*Select HereYesNoIf Yes, With Which Bank?* Location DetailsWhich year was the building constructed?*Select HereUnsure20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Before 1900Estimated square footage?*This only includes main level and upstairs. Basement square footage is excluded from this calculation.Finished basement?*Select Here100% Finished75% Finished66% Finished50% Finished33% Finished25% FinishedBasement is unfinishedNo BasementUnsureHow many kitchens?*Select Here1 Kitchen2 Kitchens3 Kitchens4 KitchensHow many storeys?*If condo is in a high-rise building select high-rise. The basement is NOT included as a storey.Select HereBungalow1-1/2 Storeys2 Storeys2-1/2 Storeys3 Storeys3-1/2 Storeys4 StoreysHigh-rise buildingHow many bathrooms?*Select Here1 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 bedrooms?*Select Here1 Bedroom2 Bedroom3 Bedroom4 Bedroom5 Bedroom6 Bedroom7 Bedroom8 Bedroom9 Bedroom10+ BedroomType of Siding?*Which type of siding is the majority of the exterior?Select HereAluminumBrickCedar SidingCementLogMetalStoneStuccoVinylWoodUnsureType of structure?*Select HereDetachedSemi-DetachedTown House in RowTown House End UnitTerrace HomeDuplexTriplexUnsure/Other (Leave Remarks at End)Which 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 Select HereNoneAttached 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 GarageCarportUnsureUse of the property?*How is the property going to be inhabited, this is important for the proper coverage to be applied to your quote.Select HereMy primary residenceIncome Rental PropertyMy secondary residence - Not a CottageSeasonal PropertyVacantBuilders Risk - Complete New BuildBuilders Risk - Existing Structure RenovationShort Term Rentals -Air BNBUnsure / Other (Leave Remarks at End)Is there a generator attached to the house?Not portable (e.g. Generac)Select HereYesNoDistance To Nearest Fire Hydrant*Select HereWithin 150 metresWithin 300 metresOver 300 metresUnprotectedUnsureDistance To Nearest Firehall*Select HereWithin 5 KM'sWithin 8 KM'sOver 8 KM'sUnprotectedUnsureIs there a swimming pool?*Does not include hot tub or sauna.Select HereNoneIn Ground ConcreteIn Ground FiberglassIn Ground VinylAbove Ground StandardAbove Ground FiberglassWhen was the pool installed?*Select HereSame Year as the HouseUnsure2030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970Prior to 1970Is the pool fenced in?*Is there a fence that surrounds the pool?Select HereYesNoNo, 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.Select Here$30,000$35,000$40,000$45,000$50,000$55,000$60,000$65,000$70,000$75,000$80,000$85,000$90,000$95,000$100,000$100,000+Business in the home?*Is there any business activity in the home?Select HereNoYesDescribe business in the home.*Please describe the business in the home. Be as detailed as possible about the business.Do you AirBnB or do any short term renting of your home*Select HereYesNoAny past insurance claims?*Select HereYesNoPlease provide details of the claim* Electrical DetailsElectrical Update*When was the electrical last updated?Select HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of electrical wiring?*Copper is the most up to date type of electrical wiring.Select HereAluminumCopperKnob & TubeMixUnsureHow many AMPS on the panel?*Can normally be found on the electrical panel. Most homes have 100 amps.Select Here60 AMPS100 AMPS200 AMPSUnsureType of electrical panel?*Breakers are the most up to date type of panel.Select HereBreakersFusesUnsurePlumbing DetailsPlumbing Update*When was the plumbing last updated?Select HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of plumbing?*Copper / ABS is the most up to date type of plumbing.Select HereUnsureCopper / ABSLeadCast IronPexPolybOtherDo you have a sump pump?*Select HereYesNoIs your sump pump alarmed?*Select HereYesNoDoes the sump pump have any auxiliary power?*ex. generator, battery pack, etc.Select HereYesNoBackup/ backflow valve?*Select HereYesNoRoofing detailsRoof Update*When was the roof last updated?Select HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of roofing material?*Most peaked roofs have Asphalt Shingle. Most flat roofs have Tar & Gravel.Select HereUnsureAsphalt shinglesClay tileConcrete tileCorrugated steelElastomerMetal tileRubberSlate tileTar & gravelWood shakesWood shinglesOtherPrimary HeatingType 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.Select HereUnsureNatural Gas FurnaceElectricOil FurnacePropane FurnaceWood FurnaceHot Water/SteamCombination FurnaceSolid FuelGas Space HeaterOil Space HeaterElectric Space HeaterWood Burning StoveFireplaceFireplace InsertSolarHeat PumpOtherNoneYear heating system was installed/updated*Select HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Type of water heater?*Select HereStandardTanklessWhen was the water heater last updated?*Select HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Do you have an Oil Tank?*Select HereYesNoOil Tank YearSelect HereUnsureOriginal20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Location of Oil tankAny Auxiliary heating?if so please describe.SecurityBurglar alarm system monitored and paid for?*Select HereYesNoWhat company monitors your alarm system*The insurance company will request a certificate numberFire alarm system monitored and paid for?*Select HereYesNoWhat company monitor the fire alarm system* Rental LocationLength of lease agreements*Number of tenants in each unit*Are any tenants students?*Select HereYesNoWill tenant's be required to have insurance?*Select HereYes, they will be required to have insurance.No, they will not be required to have insurance.How often will inspections be performed (interior & Exterior)?*Annual rental income*Landlord contents value*ex. Fridge, stove, dishwasher etc.Who will maintain the property/ act as property manager* DiscountsThis section can offer substantial discounts to your quote.Multi-Policy Discount?*If you are willing to bundle your car insurance with your property insurance you can receive a discount on each product.Select HereYes I will bundle.No I will not bundle.Smoker-Free Household Discount?*In order to be eligible no smoker can live at the house, even if they always smoke outside.Select HereYes, smoke free household.Not a smoker free household.First Time Buyer Discount?*In order to be eligible everyone listed on the title must be purchasing for the first time.Select HereYes, first time buying.No, not my first home purchase.Mortgage Free Discount?*In order to be eligible the property must not have a mortgage, a line of credit is acceptable.Select HereYes, property is mortgage free.No, this property has 1 mortgage.No, this property has 2 mortgages.No, this property has 3 mortgages.Credit 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? “Select HereYes - 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.