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Home Insurance

Home Insurance

Step 1 of 5

20%

Preferred type of home insurance:*
- Owner
- Co-owner / condo
- Tenant
- Chalet
Combined with
- Vehicle Insurance
- Life Insurance: 3 additional questions (10 seconds)
Name*
First Last
Profession*
Name of your employer*
Address*
Street Address Address Line 2 City Province Postal Code
Birthdate*
Date Format: YYYY dash MM dash DD
Main phone*
Other phone
Sex*
- Female
- Male
Civil status*
- Single
- Married
- Divorcee
- Civil partner
- Widower/widow
Spouse's name*
First Last
Birthdate*
Date Format: YYYY dash MM dash DD
Spouse's job*
Name of spouse's employer*
Email to receive the submission*

Important! Your submissions will be returned to you at this address.

Do you currently have homeowners insurance?*
- Yes
- No
How many years have you been living at the same address?*
Renewal date of your insurance policy*
Date Format: YYYY dash MM dash DD
Name of current insurer*
How many years have you been with this insurer?*

Home Insurance - Owner & Chalet
Date of acquisition of your property*
Date Format: YYYY dash MM dash DD
Year built*
Type of residence*
Type of building*
Roof type*
Number of bathrooms*
Main heating system*
Amount of wooden cord used annually
Other heating source
Do you have a garage?*
- Yes
- No
Garage type*
Garage heating system (if heated)
Approximate cost of replacement (in $)*
The year your water heater was replaced*
Does your house have a basement?*
- Yes
- No
percentage of the finish of the basement*
Approximate size of your home*
Distance from your home to the nearest fire hydrant*
Distance from your home to the nearest fire station*
Is your residence connected to a fire and theft center?*
- Yes
- No
Are the occupants of your residence non-smokers?*
- Yes
- No
Do you have a pool?*
- Yes
- No
Type of installation*
Year of installation*
Do you have a spa?*
- Yes
- No
Do you have a wood lot?*
- Yes
- No
Do you have a hunting camp?*
- Yes
- No
Do you have an accredited or private daycare?*
- Yes
- No
Year of installation*
Renovations done to your home since its construction (ex: roof, window, plumbing) and date of renovations*
Does your residence have a backflow valve?*
- Yes
- No
How much coverage do you have for rebuilding your building?*
How much coverage do you have for ground-level water damage and sewer backup?*
Home Insurance - Tenant
Number of housing in your building?*
Your home is on which floor?*
Number of bathrooms*
Home Insurance - Co-owner
Date of acquisition of your property*
Date Format: YYYY dash MM dash DD
Number of housing in your building?*
Your home is on which floor?*
The year your water heater was replaced*
Number of bathrooms*

Vehicle Insurance
Number of vehicle(s) to be insured *
Vehicle 1
Date of vehicle purchase*
Vehicle brand*
(Toyota, Honda, etc...)
Vehicle model*
(Exact model, eg Civic LX, SI, two doors, four doors, coupe or hatchback, etc ...)
Main driver*
- Applicant
- Parner
Vehicle Year*
Indicate your annual mileage*
Price paid (in $)*
State*
- New
- Used
Term*
- Purchase
- Leasing
Funding*
- With a loan
- Without a loan
Vehicle 2
Date of vehicle purchase*
Vehicle brand*
(Toyota, Honda, etc...)
Vehicle model*
(Exact model, eg Civic LX, SI, two doors, four doors, coupe or hatchback, etc ...)
Main driver*
- Applicant
- Parner
Vehicle Year*
Indicate your annual mileage *
Price paid (in $)*
State*
- New
- Used
Term*
- Purchase
- Leasing
Funding*
- With a loan
- Without a loan
Vehicle 3
Date of purchase of the vehicle*
Vehicle brand*
(Toyota, Honda, etc...)
Vehicle model*
(Exact model, eg Civic LX, SI, two doors, four doors, coupe or hatchback, etc ...)
Main driver*
- Applicant
- Parner
Vehicle Year*
Indicate your annual mileage *
Price paid (in $)*
State*
- New
- Used
Term*
- Purchase
- Leasing
Funding*
- With a loan
- Without a loan
Driver information
How long have you had your driver's license?*
Type of driver’s license*
Permit number (optional):
By entering your driver's license number, the submissions you receive will be much more accurate.
Has your license been revoked or suspended in the last 6 years?*
- Yes
- No
Date of revocation
Date Format: YYYY dash MM dash DD
Reason(s) for revocation
Number of months of revocation
Claim or loss with or without disbursement during the last six years
To be more precise, indicate the date of the incident, the amount claimed, and the percentage of responsibilities. Example: 0%, 50%, 100%.
Traffic violations during the last three years
Indicate the reasons for the infractions and the number of points lost.
Date your insurance could come into effect*
Date Format: YYYY dash MM dash DD
This date is for*
Distance traveled to work or school (in km)*
One-way
Annual mileage for business only
To visit clients or business meetings.
Your car has a lock*
- Yes
- No
Type of anti-theft system
Example: intensive markings, anti-starter, smart key, tracking system
Did you take a driving course?*
- Yes
- No
What kind of bonus would you like to receive with this submission?
Public liability*
Collision Franchise*
Franchise (fire, theft, vandalism, broken glass)*
New value*

Additional information
You are now on the last step of the form. You will probably find some questions that seem out of context; however, all questions can affect your premium and give you very good discounts on your quote.
Is there a creditor on your property?*
- Yes
- No
Do you have an animal?*
- Yes
- No
Kind of animal*
Have you made any claims in the last 6 years?*
- Yes
- No
Has your insurance policy ever been suspended canceled or refused in the last 3 years?*
- Yes
- No
Do you or someone you live with have with a criminal record?*
- Yes
- No
Is there a commercial use for the building?*
- Yes
- No
Are you a member of CAA?*
- Yes
- No
Children under 16 years old?*
- Yes
- No
In order to give you the best possible quote, will you allow us to check your credit rating and claim record?*
- Yes
- No
Amount of deductible (in $)*
Amount for personal property*
$5000 increments
Contact preference
- Day
- Evening
- At all times
How did you hear about us?
- Friend
- Coworker
- Newspaper
- TV
- Radio
- Google
- Facebook
- Other
Comment
Terms and conditions of use*
- I agree with the terms and conditions of use

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