Saturday, 27 July 2013

Home Owner Policy Quote





Basic Information

?Postal code?
?First name?
?Last name?
?Telephone number?  
?Email address?
?What type of policy would you like an estimate for?


?Effective date of the policy  

Location Information

City or town of residenceCALGARY
?Street address?
?How long have you been living at this address?
?How close is the dwelling to the nearest fire hydrant?
?How close is the dwelling to the nearest fire hall?

Applicant Information

?What is your date of birth?  
?Occupation?
?Is there a co-applicant?
?If yes, what is the co-applicant's date of birth?  
?How many years have you had residential insurance?
?How many claims have you had in the past ten years?
?Number of mortgages on this dwelling?
?Are all members of the household non-smokers?

Coverage Information

?Amount of insurance required for the residence?$ 

Dwelling Information

?Do you occupy the dwelling?
?Construction type?
?Structure type?
?Year dwelling was built?
?Number of units in the building?
?Primary heating source?
?Auxiliary heating source?

Security Information

?Burglar alarm?
?Fire alarm?
In respect of this quotation, any policy we issue and subsequent renewals or changes; we may order reports containing personal, credit and investigative information. This information, solely relating to your automobile and/or personal property policy is used in order to assess risk, investigate and settle claims and detect and prevent fraud.

Do you authorize us to collect, use and disclose this information to appropriate third parties?
By clicking on 'Next' it is understood that you have read and agreed to the Terms and Conditions.

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Auto Insurance Application



Basic Information

?Postal code?
?First name?
?Last name?
?Telephone number?  
?Email address?
?How many vehicles would you like to insure?
?How many drivers will be driving these vehicles?
?Effective date of the policy  

Driver Information - Driver 1 of 1

City or town of residenceCALGARY
?Street address?
?First name?
?Last Name?
?Date of birth?  
?Gender?
?Marital status?
?Occupation?

Licence Information

?Licence class?
?Date when you received your first drivers license in Canada?  
?Have you taken a driver training course and received a certificate in the past 3 years?

Driving History

?In what year were you first insured?
?How many years have you had continuous insurance coverage with your current insurance company?
?How many traffic tickets has this driver had in the past 3 years? (not parking tickets)
?How many claims, not involving collisions with vehicles or objects has this driver had in the past 10 years?
?How many accidents (regardless who was at fault) has the driver had in the past 10 years?
?How many times have you had your driver's license suspended in the past 6 years?
?How many times have you had your insurance coverage cancelled by an insurance company in the past 3 years?

Alberta Auto Reform Information

?Driver's grid level? (leave blank if unknown)
?Grid level relevant date? (if unknown, use current Alberta auto policy effective date)

Vehicle Information - Vehicle 1 of 1

?Vehicle year?
?Primary use for this vehicle?
?Kilometres driven annually?,000
?Vehicle anti-theft device?

Coverages

?Third Party Liability
?Collision Deductible
?Comprehensive Deductible
?Loss of Use (temporary replacement vehicle)
?Non-Owned Autos (vehicle rental coverage)
?Reduced Glass Coverage
In respect of this quotation, any policy we issue and subsequent renewals or changes; we may order reports containing personal, credit and investigative information. This information, solely relating to your automobile and/or personal property policy is used in order to assess risk, investigate and settle claims and detect and prevent fraud.

Do you authorize us to collect, use and disclose this information to appropriate third parties?
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