Home Insurance Application Form

Please fill out the home insurance application below to the best of your ability.  If you have any issues, please don’t hesitate to call us at 250-368-9188.  We will follow-up after we successfully receive your submission.

    Condition Removal Date YYYY-MM-DD (if new purchase)

    Effective Date Insurance is Required YYYY-MM-DD (required)

    How did you hear about us?

    Owner Information


    YesNo

    Secondary Applicant Information


    YesNo

    Current Insurance Company (Home/Tenants/Condo)

    Current Insurance Policy #

    Current Insurance Policy Expiry Date YYYY-MM-DD

    Mortgagee Institution

    Mortgagee Address

    Previous Address in Past 3 Years

    Have you had any claims in the past 5 years (list details)

    Have you ever been cancelled, refused, or denied insurance?

    YesNo

    Years Continuously insured (no gaps)

    Years Claims Free

    If a new primary residence, will you occupy within 30 days?

    YesNo

    How long have your owned or occupied this property?

    Occupancy of this location (required)

    Is there an alarm system? (required)

    Fire Hydrant within 300 meters? (required)
    YesNo

    Fire Hall within 8 km? (required)
    YesNo

    Detached Outbuildings(include type, size, value, siding, roofing, year built, quality):

    Will there be any roommates or boarders? (required)
    YesNo

    Will there be any business on premises? (required)
    YesNo

    Are there any suites in the home? (required)
    YesNo

    Will there be any home sharing rentals? (required)


    Will there be any marijuana grown on premises? (required)
    YesNo

    Would you like to include Earthquake? (required)
    YesNo

    Would you like to say yes to credit score discount? (required)
    YesNo

    Would you like to pay in full or monthly? (required)
    FullMonthly

    Any extensions of liability/scheduled items to add (bikes/jewellery/business property) (required)

    YesNo

    Dwelling Information

    Architecture Style (required)

    Construction Type (required)

    Construction Quality (required)

    Physical Shape (required)

    Primary Exterior Siding (required)

    Primary Roof (required)

    Bathrooms

    Description of Locale (required)

    Has the home been completely gutted in the last 40 years?

    YesNo

    Historic Registry

    YesNo

    Garage

    Carport

    Porch

    Deck

    Additional Areas

    Other


    Electrical Upgrades



    Plumbing Upgrades






    Roofing Upgrades


    Heating Upgrades



    Hot Water Tank Upgrades



    Municipal Sewer/ Septic

    Sewer Back Up Valve

    If using wood heat, how many chords are burned /year

    If using wood heat, is your unit CSA approved and WETT inspected (copy of WETT required)

    *CURRENT COLOURED PHOTOS OF FRONT, BACK OF HOME AND OUTBUILDINGS REQUIRED FOR QUOTING
    *WETT INSPECTION & COMPLETED WOODHEAT QUESTIONNAIRE FOR ALL WOOD BURNING UNITS REQUIRED
    *ALL SUITES OR RENTING OF SUITES MUST BE DECLARED PRIOR TO INSURANCE BEING BOUND