RV Insurance Application

RV & MOTORHOME APPLICATION (Please complete ALL questions)

Registered Owner:
Date of Birth:
Email:
Registered Owner #2:
Date of Birth:
Email:

Address / Postal Code:
Phone Number(s):

General

How did you hear about us:
Previous Insurer:
Expiry Date:

Unit Information

Make:
Model:
Length:
Year
VIN Number

Coverage

*Guaranteed Replacement Cost / All Risk (Newer than 10 years):

Limit: $

Deductible:—Please choose an option—$250$500$1000

**Replacement Cost / All Risk:

Limit: $

Deductible:—Please choose an option—$250$500$1000

***Actual Cash Value / Specified Perils:

Limit: $

Deductible:—Please choose an option—$250$500$1000

*(GRC) Guaranteed Replacement Cost: the insured value must equal the current retail value (brand new) of the same unit including taxes (current year, model and brand including taxes). Must contact a dealer if current retail value is unknown.
**Replacement Cost: specify the limit of coverage you would like to replace the unit with something of similar like, kind and quality; this is the maximum you would receive in a loss.
***Actual Cash Value: choose your limit, the policy will not pay out more than this amount; there is no coverage for mysterious disappearance and snow damage with this coverage.

Type of RV—Please choose an option—Travel TrailerFifth WheelTent TrailerCamper UnitPark Model

Usage: —Please choose an option—VacationFull-time TravelSnowbird (over 3 months)Full-time ResidenceFull-time WorksiteRented to others

Other Information

RV Park Name:

RV Park Full Address:

RV Park Pad # (If Permanently Parked):

Any previous claims or losses? YesNo

If yes, provide details:

Any unrepaired damage? YesNo

If yes, provide details:

Loan? YesNo

If yes, provide details:

Lifts? YesNo

Skirted? YesNo

Area of Operation: CanadaUnited States

Additional Information:

Does the Unit have any of the following Information?

Secured parking – An RV Stored indoors, including garages and warehouses with locked gates/ and or doors while at home, in storage or not in use. OR permanently parked in a secure supervised RV park
YesNo

RV Alarm – An alarm attached to and forming a part of the recreational vehicle that emits an audible alarm
YesNo

GPS Tracking – A GPS device attached to and forming a part of the recreational vehicle that sends a signal advising where the unit is located in real time
YesNo

Extra Coverage Options

Select desired options:
Increased Detached Structure LimitAwning RC Extension Approx. $25CPL 2M Approx. $125 (Good to have for permanent residence)Increased Contents Approx. $15/$1,000Contents