Rooming House Insurance 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 insuranceStep 1 of 333%Applicant DetailsYour Name* First Last Email Phone Number*Are You Currently Insured Yes NoInsurance ever cancelled or refused? Yes Nodescribe whyif on hand, upload current policyor list name of current insurance company*Policy NumberCurrent Yearly Premium ($) (Optional)How many losses/claims have you had in the past 6 years?012Loss 1Date of LossMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Amount of Loss ($)Description of LossLoss 2Date of LossMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Amount of Loss ($)Description of LossProperty DetailsLocation Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Construction DetailsYear BuiltPlease indicate the year the property was builtHouse is..DetachedSemi DetachedTown HouseRow HouseotherOtherHydrant within 150m Yes NoFire Hall within 8 KM Yes NoBurglar Alarm None Local MonitoredSmoke Alarm/ Detectors None Monitored Smoke Alarm Local Smoke AlarmHow many storiesTotal Square FootageRoofType of Roof*Wood/ShinglesWood/SteelSteel DeckConcreteOtherOtherUpdate Year*When was the roof last renovatedWallsType of Walls*Wood - Frame/VinylWood - Brick VeneerBrickMetalConcrete/ MasonryOtherOtherElectricalType of Electrical*CopperAluminumOtherType of ElectricalFusesBreakersOtherAMPs60 AMP100 & + AMPOtherOtherOtherUpdate YearWhen was the wiring redone/updatedPlumbingType of Plumbing*CopperPlasticOtherOtherUpdate Year*When was the plumbing redone/updatedHeatingType of Heat*Forced Air GasElectricalOilOtherOtherUpdate YearWhen was the heating redone/updatedType of Air ConditioningNoneCentral AirRoof TopOtherOtherBusiness OperationsSigned Rental Agreement with each Tenant? Yes NoDo You Live in the House? Yes NoWho Manages Property? You Professional Management Company OtherName of Management CompanyOtherNo Smoking Policy Enforce? Yes NoIs Cooking Allowed in Rooms? Yes NoIs there a swimming pool? Yes NoIs there a garage? Yes: 1 Car Yes: 2 Car No OtherOtherYears Experience Managing Rental PropertiesWho is Responsible for Maintenance and Repairs?Number of Tenants Living in the House123456789+Number of BathroomsNumber of KitchensHow Often is Property Inspected?CoveragesRebuilding Cost of Building ($)Contents (Appliances only) ($):Yearly Rental Income ($)Limit of Liability: $1,000,000 $2,000,000 OtherOther:Additional CommentsFileAlthough not necessary at this time, please attach anything that may help us in reviewing your property. Such as photos or tenant contracts.