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Condo and Apartment Insurance Quote

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If you are unsure of how to complete the form, have a question regarding your coverages or how the claim will be handled, please contact our office during regular business hours.

PERSONAL INFORMATION
Name: *
Email: *
Phone: *
Work:
Fax:
Address: *
City: *
Province:
Country:
Postal Code: *

CURRENT POLICY INFORMATION
Present Insurance Company:
(NOT the broker name)
Policy Number: Expiry Date:
How many years have you had condo/apartment insurance?   

YOUR CONDOMINIUM / APARTMENT
Unit Type:
Rent or Own?:
Year building was built: *
How many suites are in the building? *
Is the building fire resistive? * Yes   No
Does the unit have a centrally monitored burglary alarm? * Yes   No
Does the unit have a 24 hour security on premises? *   Yes   No
Does the unit have a business operating in the building? *     Yes   No

INSURANCE COVERAGES REQUIRED
Personal Liability

OPTIONAL COVERAGES
All condominium and apartment insurance policies contain coverage limitations for valuable items such as jewellery, furs, fine arts, silverware and collectables. You can list these items separatly on your policy for an additional premium to ensure full coverage is applied. If you require additional coverage, please provide item details:
Value of Items to be Insured
Jewellery $
Furs $
Fine Arts $
Silverware $
Bikes $
Electronics (stereo) $
Electronics (computers) $
If computer coverage is required, is it used for business?    Yes   No
If computer coverage is required, is it used away from home?    Yes   No
Other   (Description)
$

ADDITIONAL PROPERTY COVERAGES (COTTAGE)
Cottage Location
Postal Code
Year Built
Dwelling Value $
Personal Property $
Fire Protection (check all that apply)
hydrant within 300m  hydrant within 8km  unprotected

DISCOUNTS
(check all of the discounts you may be eligible for)
Age (what year were you born):
Alarm - Burglar - centrally monitored Yes   No
Alarm - Fire - centrally monitored Yes   No
Neighborhood Watch
(local security program in place)
Claims Free
(no claims in the last 3 years)
Mortgage Free

CLAIMS HISTORY
Please list all claims against your insurance policy within the past 5 years.
Date (yyyy-mm-dd) Description Amount Paid
Additional Comments:
How would you prefer to be contacted? *
Email:      Home:      Work      Fax:
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