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Home Insurance
Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Date of Birth
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)
Is there an Alarm system ?
Yes
No
Policy deductible preferred:
$500
$1000
Liability amount requested:
$1 million
$2 million
Any claims in the last three years?
Yes
No
Has any company ever cancelled or
refused insurance of this description?
Yes
No
Additional comments:
Disclaimer
