General Liability Application

Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance.

Name
First Last
Name of Your Business
Email
Phone
Have You Ever Had Any Claims?
- Yes
- No
If You Have Had Claims, Please Describe How Many, When They Occured, What Was The Payout? Is the Claim Still Open? What Has Been Done To Prevent Such Claims In The Future:
Are You Currently Insured?
- Yes
- No
Current Insurance Company Name:
How Many Years Have You Been Insured With them?
How Many Years Of Experience Do You Have in This Line of Business?
Address Location Of Your Business
Street Address Address Line 2 City Province Postal Code
Please Describe to Us Your Business Operations:
What Is Your Annual Revenue? Or Estimated Annual Revenue

Insurance companies use this as a rating criteria to see how large your business is and what the exposure can be. If this is a new business, you should provide an estimate what the gross sales might be.
Are Any Of Your Sales From Outside Canada?
- Yes
- No
Which Countries?
What % of Sales From Each Country?
Are Any Products You Sell Imported or Prepared from Outside North America?
- Yes
- No
How Many Employees Do You Have?
Do You Use Any Sub-Contractors ?
- Yes
- No
What % of Sales is Derived from Your Sub-Contractors?
Do You Require All Sub-Contractors to Carry At Least $2 Million in Commercial General Liability Insurance?
- Yes
- No
What Limits of Liability Are you Looking For?
- $2 Million
- $5 Million
- Higher

Help and SupportContact

Toronto Location

339 Roncesvalles Avenue
Toronto M6R 2M8
Phone: 416 531 4647
Fax: 416 531 2396

Tillsonburg Location

19 Ridout Street West
Tillsonburg N4G2C8
Phone: 519 842 7584
Fax: 519 842 7584

Mississauga Location

1295 Burnhamthorpe Rd E L4Y 3V7
Mississauga L4Y 3V7
Phone: 905 206 0707
Fax: 905 206 0707

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