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Home Insurance
Name:
Address:
City:
Province:
Postal Code:
(X1Y 2Z3)
Phone Number:
(123-456-7890)
Email Address:
(xxx@yyyy.zzz)
Do you own your own home,
own a condo unit or rent
?
Homeowner
Condo Owner
Renter
Estimated replacement value of dwelling: (homeowner only)
Estimated replacement value of personal property:
(condo & renters only)
Policy deductible preferred:
$300
$500
$1,000
Liability amount requested:
$500,000
$1,000,000
$2,000,000
Have you had any personal property claimed in the past three years?
Yes
No
Comments:
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