Condo Insurance Application

Applicant Details

#1

Name:

On Title? YesNo

Date of birth:

Phone:

Email:

#2

Name:

On Title? YesNo

Date of birth:

Phone:

Email:

Other Details

Property Address:

Mailing Address (if different):

Effective Date Insurance is Required:

How did you hear about us?

Are you within 300m of a fire hydrant: YesNo

Distance to fully staffed fire hall:

Insurance and Unit Information

Current Insurance Company (for condo or primary home):

Current Insurance Policy # and Expiry Date (MM/DD/YYYY):

Mortgagee Institution Name:

Mortgagee Address:

How long have you lived at this location?

Previous Address in Past 3 Years:

Have you had any claims in the last 5 years? YesNo

If yes, details:

Have you had any gaps in insurance? YesNo

If yes, details:

Years Continuously Insured (No Gaps):

Years Claim Free:

Occupancy of this location: PrimaryRentalSeasonalVacant

*If a primary residence, will you occupy within 30 days: YesNo

If loss of rental income coverage is required, what is the amount of coverage needed:

Will there be any short term rentals: YesNo

Include overland water: YesNo

Earthquake coverage required: YesNo

Building Type: ApartmentDuplexTownhouseHouseOther

If other, details:

Is there any commercial exposures: YesNo

If yes, describe:

What is the construction of the building: Wood FrameConcreteBrickSteelOther

If other, details:

How many units are in the building:

What year was the building built:

What floor is the unit on:

What is the primary heating source:

Heating Year:

Plumbing type:

Plumbing Year:

Electrical Wire Type:

Amps:

Electrical Year:

Roof Type:

Roof Year:

Does the location have a basement: YesNo

What is the personal property amount you require insured:

Strata Loss Assessment Deductible coverage limit: $

Information

Are there any: RoommatesBoarders

If yes, details:

Credit Consent: YesNo

Will there be any marijuana grown on the premises: YesNo

If yes, how many plants:

Alarm System on Unit: Local Alarm24hr Central Monitored AlarmFor FireFor BurglaryNone

How many smoke detectors:

Will there be any business on the premises: YesNo

Quote with $500 deductible or $1000 deductible: $500$1000

Is there a Hot TubPool

If yes, details:

Pay in full or monthly? In FullMonthly

Signature (type name):

Signature of second applicant if applicable (type name):