Home Insurance (Primary & Rental)
Owner Legal Full Name on Title (All Owners) Please use this format (Last Name, First Name + Middle Name)
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Gender of All Owners
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Owner Date of Birth (All Owners)
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Owner Occupation (All Owners)
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Owner Phone Number (All Owners)
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Owner Email (All Owners)
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Property Address (Place is going to insured)
Street Address
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City
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Postal code
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Previous Living Address
Full Address Including City & Postal Code
Completion Date or Own the property since?
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Occupancy Date (the day you move in)
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Will you have Mortgage on this property?
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No
Yes
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Who will live in this home? (Select all applicable)
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Myself only
My immediate family members
My extended family members
My tenants (rental)
Unrelated individuals (friend, non-rental)
Vacant
Number of Families (Parents + Children = 1 Family; Grandparents + Parents = 2 Families)
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Your household has any dogs?
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No
Yes
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Purpose of Property Use
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Primary residence
I live there and rent out a room or basement
I rent out the whole house (long term)
Airbnb & short-term rental
Seasonal home (for vacation only)
Vacant (no one would occupy this home, it's for investment purpose only)
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What's Your Primary Residence Address (including City & Postal Code)
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How many unrelated tenants living in the property?
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Are all units self-contained (separate entrance)?
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No
Yes
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Are there more than 2 unrelated individuals sharing any common areas? (e.g. kitchen, washroom)
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No
Yes
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Who is responsible for the maintenance of the rental property?
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Myself
Hired Property Manager
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Is the Exterior and INterior of the rental inspected at least every 90 days
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No
Yes
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What is the duration of the lease/rental agreement?
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Monthly
Yearly
AirBnB
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How long or since when you have the current tenants occupied the rental location?
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What is the monthly rental income?
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$
Do you currently have any home/condo/tenant insurance in force?
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Do you currently have any home/condo/tenant insurance in force?
No
Yes
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Please select all applicable regarding your existing insurance policies
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I currently have a tenant insurance
I currently have a home/condo insurance on my primary residence
I currently have a home/condo insurance on my rental properties
Please upload all your existing home/condo/tenant insurance policies for potential premium discount
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Please upload all your existing home/condo/tenant insurance policies for potential premium discount - .pdf, .docx, .doc, .jpeg, .jpg, .png, .gif
How long have you had ANY property insurance without gaps (since when)?
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Do you have any claims in the past 10 years?
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Do you have any claims in the past 10 years?
No
Yes
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Please explain the claim details including Dates & Causes
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Do you have any cancelled/declined/refused to renew from an insurance company?
No
Yes
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Please explain the details
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Do you have the MLS Sheet?
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No
Yes
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Please upload the MLS Sheet
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.pdf, .docx, .doc, .jpeg, .jpg, .png, .gif
Separate Entrance for Basement?
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Yes
No
No Basement
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Finished Basement?
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Yes, completed
Yes, partial
Unfinished
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Roofing Last Replaced (Year)
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Roofing Last Serviced (Year)
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Plumbing Materials
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Copper
Copper & PVC (Plastics)
Poly-B
Galvanized Steel
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Plumbing Last Updates (Year)
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Electric Materials
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Copper with Circuit Breaker
Copper with Fused
Aluminum with Circuit Breaker
Aluminum with Fused
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Electric AMPS
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100 AMPS
100 AMPS with 200AMPS
200AMPS
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Electric Last Updates (Year)
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Heating Last Updates (Year)
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Water Tank Age (Year)
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Oil Tank
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No
Yes
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Other Structures
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Above ground/Semi-inground pool
In-ground pool
Outdoor Hot Tub
Sauna
None
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Do you have home-based business?
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No
Yes
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Type of Property
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Single Family Home
Duplex - Request For Strata Insurance
Triplex - Request for Strata Insurance
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Property Year Built
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Number of floors, excluding basement
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1 Storey
1.5 Storey
2 Storey
2.5 Storey
1 + Basement
2 + Basement
3- Split Levels
4 Split
Side/Side Duplex
Up/Down Duplex
Triplex
Laneway House
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Separate Entrance for Basement?
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Yes
No
No Basement
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Finished Basement?
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Yes, completed
Yes, partial
Unfinished
No Basement
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Total area excluding basement (sq ft)
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Basement and/or crow space (sq ft)
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Number of Bathrooms (FULL)
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Number of Bathrooms (HALF)
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Number of Kitchens
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Roofing Materials
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Asphalt Shingles
Solar Tiles
Metal Roofing
Stone-coated Steel
Slate
Rubber Slate
Clay & Concrete Tiles
Green Roofs
Tar & Gravel Roofing
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Roofing Last Replaced (Year)
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Roofing Last Serviced (Year)
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Plumbing Materials
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Copper
Copper & PVC (Plastics)
Poly-B
Galvanized Steel
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Plumbing Last Updates (Year)
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Electric Materials
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Copper with Circuit Breaker
Copper with Fused
Aluminum with Circuit Breaker
Aluminum with Fused
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Electric AMPS
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100 AMPS
100 AMPS with 200AMPS
200AMPS
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Electric Last Updates (Year)
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Heating System
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Central Furnace/Forced Air
Electric Baseboard
Geothermal
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Secondary Heating System
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Gas Fireplace
Masonry Fireplace
Wood/Pellet
None
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Heating Last Updates (Year)
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Exterior Siding
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Brick/stone
Vinyl
Aluminum/Steel
Wood (including Wood Fiber)
Masonry/Granite
Stucco/Acrylic/Aggregated/Fiber Cement
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Water Tank Age (Year)
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Oil Tank
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No
Yes
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Construction Type
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Wood Frame
Concrete
Masonry
Steel
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Garage
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Semi-detached Garage
Detached Garage
Built-in Garage
Basement
Carport
None
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Other Structures
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Above ground/Semi-inground pool
In-ground pool
Outdoor Hot Tub
Sauna
None
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Do you have home-based business?
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No
Yes
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Select one of the options
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Paper work only, no client visit, no inventory
Stock/supplies storage at home, no client visit
Paper work and client visit my place
Client visit my place and stock/supplies storage at home
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Please explain your home-based business
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Do you want to list any valuables such as jewelry, musical instruments, wedding rings, luxury devices, etc (Additional premium may apply and must provide appraisal and receipt)
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No
Yes
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Please list all the valuables and prices
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Do you have the security system? (select all applicable)
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None
Fire Alarm Central (require certificate)
Fire Alarm Local
Burglary Alarm Central (require certificate)
Burglary Alarm Local
Sprinklers
Smoke Detectors
Community Blockwatch
How many smoke detectors?
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Request Liability Coverage
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1 Million
2 Million
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Request Earthquake Coverage?
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No
Yes (additional premium)
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Soft credit consent for additional premium discount?
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No
Yes
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Anything else I should know?
How did you find out about us?
Signature
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