Home Insurance Quote - insurancebroker.ca

Complete the form below for a home insurance quote. Only those fields outlined marked by an asterisk (*) are required fields.

Privacy Consent: By completing this form, you are giving us permission to use your information for the purpose of providing an insurance quote, apply for insurance, council or risk management service. Please read our Privacy Policy for more information.

CONTACT INFORMATION

Contact Name*

First Last

Address*

Street Address City Province Postal Code

Email*

Phone*

Reason for a new insurer or broker

LOCATION & DWELLING INFORMATION

Owner 1 Date of Birth*

Owner 2 Date of Birth

Are all members of the household non-smokers?

Yes
No

Are you retired?

Yes
No

How many mortgages are on the house?

What is the square footage of your home?

What year was your home built?

Number of Stories

What is the structure of your dwelling?

What is the exterior of your dwelling?

How far is fire hydrant from your residence?

How far is your residence from a fire hall?

Do you have a fire alarm?

Do you have a burglar alarm?

Do you, as owner, occupy the dwelling?

Yes
No

Number of families occupying the dwelling

Primary heating and/or cooling source

Auxiliary heating source if any

Electrical

Electrical - Amps

Plumbing

Roofing

Garage

ADDITIONAL COVERAGE

Enter the values of additional items that require protection below.

Jewellery

Fine Arts

Furs

Bicycles

Musical Instruments

Golf Clubs

INSURANCE INFORMATION

Current Insurance Company

Home Insurance Expiry Date

Current insured value of your home

Current or requested deductible

Number of claims in the last 5 years

How many consecutive years you have had insurance?

Details of claims if any. Include date, description, and amount paid out (for claims).

Additional Comments

OTHER INSURANCE PRODUCTS

Would you be interested in receiving a free no obligation quote for your home, auto, cottage or other insurance? Simply provide the day and month of the expiry date of your policy or policies below and we will contact you approximately 1 month prior to the expiry date.

Auto Insurance

Boat Insurance

Business Insurance

Classic Car Insurance

Cottage Insurance

Motorcycle Insurance

Personal Watercraft (PWC) Insurance

RV & Trailer Insurance

I would like to receive information on new products, services, promotions or to be reminded of my upcoming insurance renewal.

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HOME INSURANCE QUOTE REQUEST

CONTACT INFORMATION

LOCATION & DWELLING INFORMATION

ADDITIONAL COVERAGE

INSURANCE INFORMATION

OTHER INSURANCE PRODUCTS

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HOME INSURANCE QUOTE REQUEST

CONTACT INFORMATION

LOCATION & DWELLING INFORMATION

ADDITIONAL COVERAGE

INSURANCE INFORMATION

OTHER INSURANCE PRODUCTS

Pin It on Pinterest

Compare Home
Insurance Quotes