Condo Insurance Applicaton

Because of the different variables affecting your insurance premiums, we need a few pieces of information from you. To get started on your application, please fill out the following fields below. After you send it, we'll get back to you as timely as possible.

Contact Informaton --------------------------------------------------------------------------------

Last Name:

Address:

City:

Province:

Postal Code:

Email Address:

Home Phone:                   (                    )

Cell Phone:                       (                    )

Fax Phone:                        (                    )

Preferred method of contact:

Insurance Informaton --------------------------------------------------------------------------------

What style of condo?:

Type of building construction?:

If apartment, how many suites in the building?:

What floor are you on?:

Number of stories in your building?:

What is the approx. replacement value of your contents?:      $

What is the value of any improvements you've done to your condo?:     $

Are there sprinklers in your unit?:

Date of birth:

Do you have existing insurance?:

How many claims in the past 5 years:?

If you are in a rural location, how far is the
nearest firehall?:

Do you rent a room or suite?:

Do you have a security system?:

Is is monitored?:

Do you have any other property or special
items that require insurance coverage?:

First Name: