Condo Insurance Applicaton

Please fill out the following information below

Contact Informaton --------------------------------------------------------------------------------

Name:

Address:

City:

Province:

Postal Code:

Email Address:

Home Phone:                   (                    )

Cell Phone:                       (                    )

Fax Phone:                        (                    )

Preferred method of contact:

Insurance Informaton --------------------------------------------------------------------------------

What style of condo?:

Type of building construction?:

If apartment, how many suites in the building?:

What floor are you on?:

Number of stories in your building?:

What is the approx. replacement value of your contents?:      $

What is the value of any improvements you've done to your condo?:     $

Are there sprinklers in your unit?:

Date of birth:

Do you have existing insurance?:

How many claims in the past 5 years:?

If you are in a rural location, how far is the
nearest firehall?:

Do you rent a room or suite?:

Do you have a security system?:

Is is monitored?:

Do you have any other property or special
items that require insurance coverage?: