Auto Quote Home Quote Life Quote Get a Quote NowTenant Quote RequestGet a Quote - Tenant Stepped Have you ever had any cancellations, claims, or gaps in insurance? * Yes NoPlease Contact Us Before Filling Out The Form.To ensure we find the best possible options for you, please contact our staff by either emailing us or calling our office before finishing the form.Toll Free Nova Scotia: 1 866 466 9660Toll Free Prince Edward Island: 1 866 312 4242Emailinfo@cluettinsurance.ca Email * Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Phone Number * Effective Date * Date of Birth * 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? * Yes No Number of Unrelated Occupants? * 012345 Do you currently have tenant insurance? * Yes No Name of Current Insurance Provider Date since continuously insured on home or tenant policy? General Distance to the nearest fire hydrant? * Within 150 metresWithin 300 metresUnprotected Distance to the nearest fire hall? * Within 5 kilometresWithin 8 kilometresWithin 13 kilometresOver 13 kilometres Content Coverage Amount? * $35,000 $50,000 $75,000 $100,000 OtherBuilding Information Construction Type? * Wood FrameConcreteFire ResistiveBrick Structure Type? * High Rise ApartmentLow Rise ApartmentBasement ApartmentTownhouseDetachedDuplexTriflex Number of Storeys * Number of Units * Square footage of your unit? * If you are human, leave this field blank. Next
