Home Insurance Application

Section 1 of 12

Applicant information

Tell us who's applying and where the property is located.

Are you a...

Tenant

Homeowner

Applicant 1

Full name *

Occupation

Date of birth

Applicant 2 Optional — add a co-applicant if this is a joint application

+ Add a second applicant

Property & contact details

Property address *

Postal code

Mailing address same as above

Mailing address

Postal code

Contact email *

Phone number *

Section 2 of 12

Insurance history

Details about your current or most recent home insurance policy.

Is this your first time purchasing home insurance?

Yes

No

Previous claims List any claims — date, type, and payout

Loss payee information

Line of Credit

Mortgage

None

Loss payee name / details

Soft credit check agreement Credit information helps insurers assess risk and applicable discounts

Yes, I agree

No

Section 3 of 12

Occupancy

How the property is used and who lives there.

Occupancy type

Owner occupied

Rented dwelling

# of families

# of boarders

# of self-contained suites

Property management company (if any)

Is this your primary residence?

Yes

No

Vacant or seasonal

Property is vacant

Property is seasonal

Section 4 of 12

Income earning or business use on premises

Home office

No

Yes

Home-based business

No

Yes

Section 5 of 12

House details

Alarm & safety systems

Alarm system

Sprinkler system

Smoke detectors

Smoke-free home?

Oil tank on property?

Property history

Year built

Full renovation (down to studs)?

Registered heritage home?

Cannabis cultivation

No

Yes

Section 6 of 12

Construction and upgrades

Heating

Fuel type

Apparatus

Year installed

Upgrades or maintenance

Other heat source

None

Yes

Wiring

Amps

Panel type

Wiring material

Copper %

%

Aluminum %

%

Knob & Tube %

%

Plumbing

PVC %

%

ABS %

%

PEX %

%

Poly-B %

%

Copper %

%

Galvanized %

%

Which pipes (specify locations/mix if applicable)

Hot water

Standard tank

Hot water on demand

Section 7 of 12

Structure

Square footage

Upper floor (sq ft)

Main floor (sq ft)

Basement (sq ft)

Basement finished %

%

Walkout basement?

Construction type

Interior

Full kitchens

Wok / spice kitchens

Full bathrooms

Half bathrooms

Exterior finish

Stone veneer %

%

Brick veneer %

%

Wood veneer %

%

Other exterior materials

Aluminum

Stucco

Vinyl

Cement Fibre Board

Air conditioning

No

Yes

Section 8 of 12

Additional structures

Garage / carport

Garage

Carport

None

Coach house

No

Yes

Deck

No

Yes

Section 9 of 12

High value items

We recommend listing high-value items and their estimated cost — jewelry, bicycles, collectibles, stamps, watercraft, fine art, furs, business property, or other valuables.

Section 10 of 12

Pools, hot tubs & ponds

Pool

No

Yes

Hot tub

No

Yes

Pond

No

Yes

Section 11 of 12

Policy coverages

Current dwelling coverage ($)

Deductible ($)

Liability

Additional coverages

Earthquake

Overland water

Sewer backup

Ground water

Rental income

Yes

No

Glass policy

No

Yes

Additional notes

Section 12 of 12

Review & submit

Check your answers below, then sign to confirm the information is accurate.

Signature

Type your full name to sign *

Date coverage required

Date submitted

Producer / CSR (broker use)

Applicant information

Are you a...

Applicant 1

Applicant 2 Optional — add a co-applicant if this is a joint application

Property & contact details

Insurance history

Is this your first time purchasing home insurance?

Previous claims List any claims — date, type, and payout

Loss payee information

Soft credit check agreement Credit information helps insurers assess risk and applicable discounts

Occupancy

Occupancy type

Is this your primary residence?

Vacant or seasonal

Income earning or business use on premises

Home office

Home-based business

House details

Alarm & safety systems

Property history

Cannabis cultivation

Construction and upgrades

Heating

Other heat source

Roofing

Wiring

Plumbing

Hot water

Structure

Square footage

Interior

Exterior finish

Air conditioning

Additional structures

Garage / carport

Coach house

Deck

High value items

Pools, hot tubs & ponds

Pool

Hot tub

Pond

Policy coverages

Additional coverages

Rental income

Glass policy

Additional notes

Review & submit

Signature