Have you had any cancellations, claims, or gaps in insurance? *
As your broker, I am gathering this consent on behalf of the insurer who advises me that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, 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 and in accordance with our privacy policies.
Do you, and on behalf of others listed, authorize use 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, determine eligibility and conditions for a premium payment plan, investigate and settile claims, analyze business results and detect and prevent fraud?
Do you agree with the following consent statement? *
Do you Have A CAA Membership? *
Do you operate a business out of your home? *
Home-Based Business Details
Do you have a mortgage? *
Finished, Partially Finished, or Unfinished Basement? *
Are there any additional structures on the property? i.e. shed, garage, swimming pool, etc. *
Dates / Details
Is this your primary residence? *
Will you be moving to this address within 14 days of you coverage start date? *
Are there any renter or boarders? *
If Furnace - Oil, where is the oil tank located?
If Furnace - Oil, what is the oil tank construction type?
Do you have a secondary heat source? *
Do you have a Hot Water Tank? *