Home Insurance

PERSONAL INFORMATION
Name:
Birthdate:
Phone 1:
Phone 2:
E-mail:
Current Address:
City:
Province:
Postal Code:
Occupation:
Effective date of policy:
SPOUSE
Name:
Birthdate:
Phone 1:
Phone 2:
Email:
Occupation:
PROPERTY
Address:
City:
Province:
Postal Code:
Rebuilding cost:
Year Built:
Square Footage:
Occupancy Date:
Number of Stories/Dwelling Style:
Flooring (types and percentage):
Exterior (brick):
Basement completion (percentage):
No. of bathrooms (full/half):
Dwelling Mechanical Systems:
Electrical:
Wiring:
Amps:
Panel:
Hot Water tank:
Plumbing:
Year of Upgrades:
Distance to Hydrant or Firehall:
UPGRADES
Roof:
Plumbing:
Fireplace(s):
Deck (sq.ft):
Front Porch (sq.ft):
COVERAGE
Liability limit:
Deductible:
Sewer Backup:
Limit Required $:
Identity Theft:
Limit Required $:
Pool:
Square Footage:
DISCOUNTS
Mortgage:
Line of Credit:
Smoker:
Previous Claims:
Previous Insurance:
Name of Company & Policy #:
COMMENTS
Alarm: