Cottage / Seasonal & Secondary 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

General Information

Applicant Name

First Last

MAILING address

Street Address City Province Postal Code

address to receive mail

Phone

Date of Birth

Month

Day

Year

Have You Ever Had Insurance Cancelled, Not-Renewed or Denied for any reason?

Yes

Have You, Or The Location In Question, Ever Experienced Any Property Claims, Whether Covered By Insurance Or Not?

Yes

Please describe the type of claim or damage that occurred. Could you also provide the date it happened, the payout of the claim, and whether it was processed through insurance? Additionally, please specify if the claim has been closed.

Property Details

Address

Street Address City Province Postal Code

Address of the Property Seeking Insurance For.

Year Built

The year the dwelling was constructed.

What Best Describes The Property

Primary Residence: Used primarily as the main living residence

Seasonal/Vacation Home: Used occasionally during certain seasons or for vacations

Weekend Retreat: Primarily used for weekend getaways

Rental Property- Short Term: Rented out to others for short term stays

Rental Property – Long Term: Rented out to otehrs for longer periods (e.g. 1 month to a year)

Mixed Use – Personal and Rental: Used both as a personal retreat and rented out at different times.

Other

Other, Use: Please Describe

What Best Describes How the Property Is Owned

By 1-2 Family Members

By 3 or More Family Members

Property in a Corporation

By Investors

Property is in a Trust

Other

Is There a Mortgage on The Property?

Yes – Just 1 with bank or credit union

Yes – 2 with bank or credit union

Yes – 1 mortgage or more with private lender or lender other than bank or credit union

How Many Years Have you Had Continuous House Insurance for?

How long have you had house insurance on this property for?

What is the date the property was first purchased or if it a new purchase, what is the closing date?

Property Ownership-Other, Describe

Is This Property on an Island?

Yes

Does This Property Have Accessible Road Access All Year Round?

Yes

Accessible meaning the roads are kept all year round.

Is This Property on Water

Yes

Such as beside a lake or river.

Is There a Dock

Yes – Permanent Dock

Yes – Dock Which is Placed in for the Season

Is the Dock wood or plastic?

Wood – Regular

Wood – IPE or similiar hardwood

Plastic

Other

How Many SQF is the Dock?

Is The Property Hydrant Protected?

Yes – Within 150M

Yes – Within 300M

Does The Property Have a Firehall Within 7KM?

Yes

Is the Property on a Septic System?

Yes

Is the cottage on a septic system?

Yes

Is there a pump for the septic system or is it gravity?

Yes – there is a pump

No – Gravity Fed

What Best Describes the Firehall

Fully Stationed 24/7 by Career Firefighters

Volunteer Firefighters

Name of Firehall

Is There Any ICF Construction?

Yes

If ICF – Is All Stryofoam Covered With Drywall?

Yes

How Many Stories is the Home?

What is the Square Footage Above Grade?

How many square feet is the basement

What %percentage is the basement finished?

How Many Bathrooms are there?

Is there any type of swimming pool or hot tub?

Yes

Please Check if the Property Has any of the Following:

Monitored Burlgar Alarm

Local Burglar Alarm

Heat Sensor

Cameras Connected to Internet

Is There a Backup Generator?

Yes

Exterior Siding – Check All That Apply

Vinyl

Wood

Stone

Fiber Cement

Metal

Stucco

Other

Other – Exterior Siding

Please Describe

Roof Material

Asphalt Shingle

Metal

Wood / Cedar Shake

Tile / Slate

Rubber

Membrane

Type of Electrical

200 AMP OR MORE WITH Breakers – COPPER WIRING

100 AMP WITH Breakers – COPPER WIRING

LESS THAN 100 AMP WITH Breakers – COPPER WIRING

100 AMP OR LESS WITH FUSES – COPPER WIRING

100 AMP OR LESS WITH BREAKERS OR FUSES – ALUMINIUM WIRING

OTHER

OTHER ELECTRICAL – DESCRIBE:

TYPE OF HEATING – Check All that Apply

Furnace

Air Handler

Boiler

In-Floor Hydronic Radiant

No Heat

Other

OTHER HEATING – DESCRIBE:

Type of Heat Source

Propane

Wood

Natural Gas

Oil

Electric – Grid

Electric – Grid/Solar

Electric – Solar

Other

Other Heat Source

Please Describe

Type of Plumbing

COPPER

PEX

OTHER

OTHER PLUMBING – DESCRIBE:

What Year Was the Roof Updated

What Year Was the Electrical Updated

What Year Was the Plumbing Updated

Are There ANY Wood Burning Appliances

YES

such as wood burning inserts, wood burning furnaces, wood burning fireplaces or wood burning stoves..etc

Wood Burning:YES – Are the Appliance(s) WETT Certified WIthin The Last Year

YES

Are Wood Burning Appliances or Chimney Cleaned Annually By WETT Certified Technician

YES

How Many Cords a Year are Burned Annually with Wood Burning Appliances?

cord: a pile 8 feet long, 4 feet high and 4 feet wide

Please Describe Procedure to Remove of Ashes

Describe Detached Structures – Check All That Apply

There is a Boat House on Land

There is a Wet Boat House (Boat House on Water)

There is a detached 1-2 Car Garage

There is a detached 1-2 Car Garage with Bunkie/Living Quarters

There is 1-2 Sheds Under 200 SQF each

There are other or more detached structures

Other/More Detached Structures – Please Describe Each Structure and Their Estimated Rebuilding Value, As Well as the Year Built

Are There Any Saunas in or on the Property

Yes

Additional Risk Questions

Does the Property Go Vacant for More than 30 days?

Yes

Does the Property Have Any Tractors, Watercraft,, Canoes, Kayaks..etc, Bicycles, Off-Road Vehicles for Use?

Yes

What kind of vehicles or watercraft does the property have for use?

Is The Property Currently Under any Fire or Flood Advisory within 50KM?

Yes

Disqualified from quoting

Additional Information

We understand that secondary properties and cottages can be very unique. Please describe to us any unique features or exposures of the property which may be relevant.

Coverages

Building Coverage $

Detached Structure Coverage $

Contents Coverage $

Rental Income $

Liability Coverage

$2 Million

$5 Million

Require Sewer Backup and Overland Water Coverage?

Yes

Untitled

Consent(Required)

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Cottage / Seasonal & Secondary Insurance Application

General Information

Property Details

Additional Risk Questions

Coverages

Toronto

Mississauga