Primary Phone Number:
Last move date (years at primary address):
Year previous property insurance history?
Property claims in the last 10 years?
If yes: List type and date of claims:
Date of birth and occupation of each person on title of property:
Protection of property:
Mortgage on property?
Dwelling type? (two storey, bungalow, etc)
Approximate rebuilding cost?
Type and age of roof:
Type and age of plumbing:
Type and age of heating:
Type and age of electrical:
If home is over 25 years old, dates of updates for roof, plumbing, heating and electrical?
Does home have sump pump and backwater valve installed?
Number of washrooms in home:
Monitored alarm system?
Deductible on policy?
Sewer backup endorsement?
Identity theft endorsement?
Scheduled contents? (jewelry, fine art, etc)
Boat / motor / trailer coverage?
Deductible on policy:
Suite 100, 12204 – 106 Avenue
Edmonton, AB, T5N 3Z1