Home Insurance Quote Name: Address: City: Province: Postal Code: Phone: Email: Do you own your home, own a condo unit or rent: —Please choose an option—HomeownerCondo OwnerRenter Estimated replacement value of dwelling (homeowner only): Estimated replacement value of personal property: Policy Deductible Preferred: $1,000$500 Liability limit requested: $2,000,000$1,000,000 How many years have you consistently had a property policy in force: Number of claims in the past 10 years: How many years since last at fault claim (if within 10 years): Do you smoke: —Please choose an option—YesNo Do you have a monitored alarm (fire & burglary): —Please choose an option—YesNo Do you have a mortgage/secured line of credit on the property: —Please choose an option—YesNo What is your occupation: How many years since last time you moved: What is your age? (or oldest age of named insured person): Was your prior policy canceled for non-payment: —Please choose an option—YesNo Was your policy lapsed for any other reason by the insurance company: —Please choose an option—YesNo What is the amount of jewelry required to be scheduled Which insurance company has your current auto insurance:
