Home Insurance Quote Home Form What is the address of the home you want to insure? What is the address of the home you want to insure? What is the address of the home you want to insure? What is the address of the home you want to insure? 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When did you purchase this property? Describe your property? Detached Semi Detached Townhouse Condo Which year your home was built? 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 What is the square footage of your home? Is your basement finished? Yes No Is your basement rented? Yes No Which year roof was replaced? 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 Which year furnace was replaced? 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 Which year hot water tank was replaced? 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 Which year electrical wiring was last updated? 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 Which year plumbing was last updated? 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 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 Do you operate a home-based business? Yes No Do you have any high-value items that you want to protect? Jewellery Worth more than $5000 Bikes worth more than $2000 Non-motorised Watercraft worth more than $2000 Fine arts worth more than $5000 Wine and Spirits more than $5000 What is the combined value ? Do you have centrally monitored fire and burglary alarm? Yes No Do you have any property claims in last 5 years? Yes No What was the claim about? When did it happen? Do you have mortgage on your home? Yes No When did you purchase your first home insurance in Canada (including tenants insurance)? Which insurance company do you have coverage with right now? How long have you had your current insurance policy with this company? First Name Last Name Date of Birth Occupation Marital Status Singe Married Gender Male Female Phone Email Remarks ((Please specify name, date of birth and occupation of the person if there is more than one person on the title of your home) Do you want to bundle with auto insurance? Yes No If you are human, leave this field blank. Submit
