6210 147b St. Surrey, BC
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Call (604) 368-0001
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House Insurance Policy Quote Form
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Property Details
Are you a first-time home buyer?
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I need insurance for:
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New Property
Existing Property
Property Address
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Lived There Since
Previous Property/Mailing Address
Living there since
People on Title
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Your phone
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Full Name
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Date of Birth
Occupation
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Previous Insurance/Claims History
Company Name
Policy Number
Insured Since
Policy Expiry Date
Cancelled or Declined?
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Cancelled
Declined
Have you had any insurance claims?
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Date & Type of Loss
Paid Out Amount ($)
Paid By
Was Renewal Offered?
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Seniors & Pets
Is there a senior living with you, who is not on title?
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Senior Name & Date of Birth
Any Pet?
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Breed
Occupancy & Mortgage
Occupancy Type
Homeowner
Rental
No. of Families
No. of Adults
Monthly Rental Income
Is there a mortgage on this property?
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Number of Mortgages
Mortgagee / Lender
Building Details
Age of Building
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No. of Stories
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1
2
3
Number of basements
Total Area (Sq. ft.)
Area - Upper Level (Sq. ft.)
Area - Main Floor (Sq. ft.)
Area - Basement (Sq. ft.)
Wall Height (in ft.)
Hardwood Floor (Sq. ft.)
Carpet (Sq. ft.)
Tiles (Sq. ft.)
Lino (Sq. ft.)
Porch (Sq. ft.)
Sundeck (Sq. ft.)
Full Washrooms
Half Washrooms
Roof Material
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Asphalt Shingles
Metal
Clay Tile
Wood Shingle
Slate
Other
Heating Type
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Forced Air Furnace
Baseboard Heaters
Radiant Heating
Boiler
Heat Pump
Other
Type of Electrical Wiring
Total Amps
Exterior Type (if multiple types, mention all with percentage)
Plumbing Type (if multiple types, mention all with percentage)
No. of Fireplaces
Fireplace Type
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Electric
Gas
Wood
Chimney Type
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Inside
Outside
Woodstove Present?
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Garage/Carport
Garage Type
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Attached
Detached
Built-in
Garage Size
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1 Car
2 Car
3 Car
Detached Structures and Features
Any Detached Structures?
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No
Is there a detached Garage?
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No
Total Area (sq. feet)
Is there a Laneway House?
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Yes
No
Total Area (sq. feet)
Number of Washrooms
Fireplace
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No
Miscellaneous Features
Do You Have a Swimming Pool?
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No
Do You Have an Intercom?
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No
Do You Have a Jacuzzi?
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No
Do You Have Built-In Vacuum?
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Yes
No
Total Number of Smoke Detectors
Total Number of Skylights
Do You Have a Garage Door Opener?
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Yes
No
Total Number of Windows
Window Types
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Double Glassed
Single Glassed
Do You Have an Alarm System?
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Alarm Type?
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Fire
Theft
Monitoring Type?
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Local
Monitored
Coverage Required
Do You Require Earthquake Coverage?
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Do You Require Glass Coverage?
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No
Other Coverage
House Updates
Please Mention All the Updates Done in the Recent Past
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