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Home/Tenant Insurance
Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Do you own your own home,
own a condo unit or rent?
Homeowner
Condo Owner
Renter
Are you currently insured?
Yes
No
Name of previous insurance company:
Estimated replacement value
of dwelling (homeowner only)
Estimated replacement value of
personal property (condo & renters only)
Policy deductible preferred:
$500
$1000
Liability amount requested:
$1 000 000
$2 000 000
Have you had any personal property claimed in the past three years?
Yes
No
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