Existing Client Information Update

Primary Applicant

First Name*
Last Name*

Email*

Phone*
Date of Birth*

What is the physical address of your home?*

Please include your City or RM and postal code

Secondary Applicant

First Name
Last Name

Date of Birth Second Applicant

Are there any smokers in the household?
YesNo

May the quoting companies collect your credit score?
Some companies give an additional discount based on your Credit Score. Please note that this will not affect your credit rating or history and your credit information will not be shared with any third parties, including us.
YesNo

General Details

Fire Protection
Fire Hydrants within 300 m and Firehall within 8 kmResponding Firehall within 8 km, no Fire HydrantsResponding Firehall between 8-13 km, no Fire HydrantsResponding Firehall over 13 km, no Fire HydrantsNo Hydrants or Firehall

Do you run a business out of your home?
YesNomaybe If yes, please describe.

Do you own any other locations? (e.g. cottage or rental property)?
YesNo

Home Details

Please provide some details about your primary residence.

How would you describe the design of your home?*
StandardCustomizedArchitecturally Designed

What is the square footage of your home (not including basement)?*

What year was your home built?*

How many stories is your home?*
1 Storey1-1/2 Stories2 StoriesBi-LevelOther

What is the physical shape of your home?*
SquareRectangleContemporaryL-ShapedOther

What comprises the majority of the siding on your home?*
StuccoVinylBrickOther

How many Bathrooms in your home?

Full Bathrooms
0123More Half Bathrooms
(Toilet & sink)
0123More 3/4 Bathrooms
(Toilet, sink & shower)
0123More

Roofing Type*
Asphalt or Fiberglass ShinglesMetalWood ShinglesOther

What year was the roofing last replaced?*

Please describe your basement*
Below GradeWalk-outCrawl SpaceSlab

Is your basement finished?*
Yes, Fully FinishedYes, Partially FinishedNoN/A

Please describe your garage and outbuildings

Attached
None1 Car2 Car3+ Cars Detached
None1 Car2 Car3+ Cars Carport
None1 Car2 Car3+ Cars

Sheds, gazebos, workshops or other structures:
YesNo

How big is your porch, deck and/or sunroom? (describe each)*

Do you have a hot tub?
YesNo

Do you have a pool?
YesNo

What kind of plumbing do you have in the house?*
Select all that apply.
CopperPlastic (PVC or PEX)GalvanizedOther Other: Please identify

What kind of water and backup protection do you have?*
Select all that apply.
Sump pump in a pitIn-line backwater valveCentrally monitored water alarmNoneOther Other: Please identify

What kind of wiring is in your house?*
Select all that apply.
CopperAluminumKnob & TubeOther Other: Please identify

Describe your electrical panel.*
Select all that apply.
FusesCircuit Breakers - 60ampCircuit Breakers - 100 ampCircuit Breakers - 200 amp or moreOther Other: Please identify

How is your home heated?*
Select all that apply.
Forced AirBoilerElectric BaseboardsGeo-ThermalOther Other: Please identify

What year was your heating last replaced?*

Do you have a wood stove or other solid fuel heating apparatus?
YesNo

Please describe any other features of the home, not listed above, that may affect the value of the home?

Describe your alarm system
Professionally installed Burglar AlarmMonitored Burglar AlarmMonitored Burglar and Fire AlarmNo Alarm Other: Please identify

Please provide the name of the company that installed and/or monitors the alarm.

Do you currently have a Mortgage or Line of Credit secured against your home?
YesNo If Yes, which institution?

Consent and Disclosure: By selecting "I agree" below, you are authorizing us to contact you regarding your insurance. You are also declaring that all the information you have provided is true, correct and complete, to the best of your knowledge. You also understand that any information that has been incorrectly entered may affect the premiums quoted. In the event an insurance contract is accepted by you, willfully misrepresenting any information may void the insurance or be considered insurance fraud punishable by law. A copy of your response will be emailed to the address that you provided.
I agreeI disagree