Property Insurance Form

First, a bit about you...

We'd like to collect some basic information.

Primary Phone

Email *

Primary Contact Person *

First

Last

Primary Contact Person's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Contact Method

Phone
E-mail

Tell us about your property:

Please select the choice that best represents this property.

The building is owned by me and occupied as my primary residence.
The building is owned by me and occupied as my second residence.
The building is owned by me and rented to others.
The building is owned by a condo corporation and the unit is owned by me.
The building is owned by someone else and rented by me.

Tenant

THIS IS THE RED PART

Contents Limit

Building Type

Building Age

Heat Type

Insurance History

THIS IS THE YELLOW SECTION

What is the total number of years you have carried personal property insurance (including previous residences)?

Current Insurance Company:

How many years has this been insured?

What is your renewal date?

Is this a new property for you?

When are you taking possession?

General Information

YELLOW SECTION

Physical Address of the Property

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Individuals on Title

Mortgage Company

Claims History

Please list all claims over the previous 10 years.

How many claims have you made on this property over the past 10 years?

Selected Value: 0

Claims Description

Date

Claims Description

Date

Claims Description

Date

Claims Description

Date

Claims Description

Date

Building Information

YELLOW PART

Age of the building:

Owned Since:

Building Type:

Number of Units:

Distance to firehall (km):

Are there fire hydrants in the area?

Is this a mobile home?

Building Style

Foundation Type

Skirting

Square Footage (Total)

Square Footage (Total above ground)

Square Footage (Total below ground)

Building finishings:

Overall Construction Quality:

Siding Type:

Roof Type:

Flooring Type:

Heat Sources:

Wood Stove:

Electrical Type:

Electrical Panel:

Electrical Service:

Plumbing Type:

Full Baths:

Partial Baths:

Basement Type:

Basement Finish:

Garage Type:

Garage Finish:

Year of Updates:

Roof:

Water Heater:

Furnace:

Major Reno:

Protection Services and Devices:

Monitored Alarm System:

Monitoring Company:

Services included:

Septic System:

Backup Valve:

Sump Pump

Water Shutoff

Structures on Premises

How many structures do you have?

Selected Value: 0

Type:

Value:

Type

Value

Type

Value

Type

Value

Type

Value

Is this property seasonal use?

What is the use of the property?

How often is the location occupied and by whom?

Is the property available for rentals when unoccupied?

High Value Items or Collections

Tell us about the other items you will want to insure as part of your property insurance.

Please check all that apply.

Jewelry
Antiques
Wine/Liquor
Fine Art
Electronics
Lawn Tractor
Holiday Trailer
Other

Jewelry