Skip to primary navigation
Skip to main content

Humberview Insurance

Landlord Insurance
Car Insurance
Home Insurance
Business Insurance
News
Contact Us

Home 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.

Name
First Last
Phone
Email
Date of Birth
MM-DD-YYYY
Have You Ever Had A Cancalletion for Non-payment, claims or cancelled for Any Other reason?
- Yes
- No
If Cancelled Please Describe, When Cancelled and for what:
Are You A First Time Home Buyer?
- Yes
- No
Have You Ever Had Any Claims?
- Yes
- No
If You Have Had Claims: Please Describe, How Many Claims, The Date, What Occured and How Much The Claim Was For:
Is this A Smoke-Free House Hold?
- Yes
- No
Absolutely no one living in the household smokes
How Many Mortgages Do You or Will You Have On The Property?
How Many Years Have You Had Continuous House Insurance?
How Long Have You Had House Insurance On The Current Property?
How Many Years Have You Had The Property Insured With The Same Insurance Company?
Property Details
Address for House Insurance
Street Address City Province Postal Code

This Application is for primary house insurance, where you live there as the homeowner.
Please Confirm If you Live in The House:
- Yes I Live in the House
- No I Live Elsewhere
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 unit
What Year Was The House Built:
Type 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 Describe
Type of Heating
- Central Furnace
- Radiator / Boiler
- Electric Baseboard
- Other
Type of Heating - Other - Please Describe
Heating 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 Describe
Type Of Roof:
- Ashphalt Shingle
- Metal - Tile / Standing Seam
- Other
Other Type of Roof - Please Describe
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
Consent*
I agree to the Privacy Policy

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

Landlord Insurance
Car Insurance
Home Insurance
Business Insurance
Contact Us
Advice News Blog
About Us
Terms & Conditions
Privacy Policy

COPYRIGHT © 1982‐2020, HUMBERVIEW INSURANCE ALL RIGHTS RESERVED