Get a Quote for Homeowner’s Insurance

Thank you for your interest regarding a quote for your home insurance coverage. In order for us to get started would you please confirm the following regarding your insurance (Please note that it is very important to provide us with complete and accurate detail to avoid misrepresentation that could void a policy or affect a claim).


Please enter in the following information:

Yes
No

As your broker, I am gathering this consent on behalf of the insurer who advises me that: In respect of this quotation, we may collect, use and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law. Do you, and on behalf of others listed, authorize us to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, investigate and settle claims, analyze business results and detect and prevent fraud?

Yes
No

Home Insurance particulars

Owner Occupied
Condo
Tentant
Rent
Borders
None
Yes
No
Yes
No
Builder's Grade
Custom Upgrade
Yes
No
Yes
No
Attached
Built-In
Detached
Yes
No
Upgrade
Standard
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Town Water
Well
Yes
No
Yes
No
Yes
No
Yes
No
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