Estate of Home Insurance 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 PhoneEmail What is Deceased's Date of BirthMM-DD-YYYYHave There Been Any Cancalletions for Non-payment, Claims or Cancelled for Any Other reason? Yes No If Cancelled Please Describe, When Cancelled and for what:Have There Been Any Claims on The Property in The Last 6 Years? Yes No If There Have Been Claims: Please Describe, How Many Claims, The Date, What Occured and How Much The Claim Was For:How Many Mortgages Are There or Will Be On The Property?How Many Years Have There Been Continuous House Insurance On This Property?Estate Property QuestionsWhat is the Estate Name on Title? “In the Estate of ____"What is the Estate Executor's Name?Has Probate Been Completed? Yes No What is the Current Status of the Home? Vacant Being Renovated Rented Occupied by Deceased’s Children Occupied by Deceased Other Family What Date Did Vacancy StartDescribe The Type of Renovations, The Value to Be Spent. Please Confirm if There Will Be Any Strucutral Renovation, Addition, Gas, Heating, Electrical or Roofing Completed.Please Describe Family Relation to DeceasedWhat Will Be the Future of the Home? To Be Sold To Be Rented To Be Renovated To Be Occupied by Executor Other Other: Please DescribeProperty DetailsAddress for House Insurance Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code This Application is for primary house insurance, where you live there as the homeowner.Is Any Part Of The House Rented Out? Yes No Is The Rented Portion of the House its Own Unit? Yes No Unit: a portion of the house that has its own separate entrance, separate kitchen and bathroom and is not shared with other occupants of the house, other than the people living within that specific unitWhat Year Was The House Built:Are There any Business, Commercial or Farming Activities on The Property? Yes No Business, Farming or Commercial Activities – Please DescribeType of Electrical Panel: Breakers Fuses Other Electrical Panel Amperage 100 200 More than 200 Less than 100 Type of Wiring: Copper Aluminum Copper / Aluminum Mix Knob & Tube Mixed / Other Other – Please DescribeType of Heating Central Furnace Radiator / Boiler Electric Baseboard Other Type of Heating – Other – Please DescribeHeating Fuel Natural Gas Propane Oil Other Heating Fuel Other: Please Describe:Any Fireplaces or Wood Stoves? Yes No Type of Plumbing Supply Lines: Copper Pex Kitec Galvanized Steel Other / Mix Other / Mix Plumbing Lines – Please DescribeType Of Roof: Ashphalt Shingle Metal – Tile / Standing Seam Other Other Type of Roof – Please DescribeWhat Year Was the Roof Last Replaced?Is There A Basment Yes – Finished 100% Yes – Finished 50% Yes – Finished Less than 50% No Basement Does The Property Have A Backwater Valve Installed? Yes No Does The Property Have A Sump Pump Pit? Yes No Does The Sump Pump Have An Alarm with Battery Backup? Yes No Is There A Garage Yes – Attached Yes – Detached No Consent* I agree to the Privacy Policy and acknowledge the Disclosure Statement.
