Personal Property Quotation Form

- HOMEOWNERS - CONDO - TENANT - SEASONAL - -RENTAL DWELLING INSURANCE -

Name:*required*
Street Address:
City:
Province:

Email Address:*required*
Best place to contact you with our quote
Business Home Email
Contact phone numbers: *required* Residential
Business    
2. PROPERTY INFORMATION:
ADDRESS-LOCATION 1 OCCUPANCY STRUCTURE TYPE PROTECTION YEAR BUILT
ADDRESS-LOCATION 2 OCCUPANCY STRUCTURE TYPE PROTECTION YEAR BUILT
If your home is over 20 years old, indicate year the following were last renewed:
Check Location: Location 1 Location 2
Electrical                 
Heating                 
Plumbing                 
Roofing                 
3. COVERAGE INFORMATION: (enter the limit of coverage you presently carry)
Location 1 Coverages Building
(if owned)		 Personal Property Legal Liability Deductible Present Form
Location 2 Coverages Building Personal Property Legal Liability Deductible Present Form
4. ADDITIONAL ITEMS/FLOATERS TO INSURE (if applicable):
Scheduled Items Value of items: Sewer Backup Watercraft/Trailer (year/make/value/h.p.)




Location 1:
Yes
No

Location 2:
Yes
No
5. BACKGROUND INFORMATION:
(this information will determine rating information and whether discounts can apply)
Details of claims-past 5 years Present Insurance Company Name Present Annual Premium Insureds Occupation Date of Birth
(yr/mo/day)


6. COMMENTS OR ADDITIONAL INFORMATION:




Thank you for completing this form.

Copyright © CIIBIS Inc. All Rights Reserved. Legal Disclaimer.