Auto Insurance Quote Auto Form Coverage Effective Date Vehicle Details Vehicle Make Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Vehicle Brand Vehicle Model Vehicle condition at the time of purchase New Used Demo Owned or Leased? Owned Owned(financed) Leased Date of purchase What is the approximate average annual driving distance (km) for this vehicle? 1000 KM 2500 KM 5000 KM 10,000 KM 15,000 KM 20,000 KM 50,000 KM Other Enter Annual Driving Distance (in KMs) Select the choices that apply to your annual driving distance, if applicable: Commute to work or school Used car for business purpose Please advise your one -way commuting distance Please provide the annual kms used for business Parked at Night? Parking lot Private Driveway Private Garage Street Underground Parking Secure Condo/Apt Garage Unsecured Condo/Apt Garage or Lot Do you put four winter tires on this vehicle from December 1 to March 31 every year? Yes No Do you want to sign up for safe driving program (Telematics – Smartphone app)? Yes No Coverage required? Full Third Party Add New Vehicle Remove Vehicle If you are human, leave this field blank. Next
