Office 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 insurance Step 1 of 2 50% Your Name First Last Company NameEmail PhoneWebsiteAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Insurance Ever cancelled or Refused Yes No Describe WhyAre You Currently Insured? Yes No If Possible, Please Upload Current Insurance PolicyOr: Name of Current Insurance CompanyPolicy NumberCurrent Premium Per YearHow Many Claims/Losses Have You Had in Last 6 Years?012Loss 1DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Describe LossAmount of Loss ($)Loss 2DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Amount of Loss ($)Amount of Loss ($) Building DetailsType of BuildingPlaza/Strip MallOffice BuildingHouseOtherOtherNumber of Floors (#)Building Year BuiltHydrant with 150m? Yes No Sprinklered? Yes No Burglar Alarm Local Monitored None Smoke Alarm Local Monitored None Square Footage Business Occupies (sqf)Operation DetailsDescribe Business OperationsYears in Business# of Employees Including yourselfAnnual Sales ($)CoveragesCommercial General Liability$ 1 Million$ 2 Million$ 3 Million$ 5 MillionTenants Legal Liability$ 100,000$ 250,000$ 500,000$ 1 MillionOffice Contents$ 50,000$ 100,000$ 150,000$ 200,000OtherOtherAdditional Comments