Rental 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 insurance Name First Last Your MAILING Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Contact Telephone NumberYour Contact Email Your Date of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do You Have a Home or Condo Insurance Policy On Your Primary Residence? Yes No Do You Live in the Rental Property Yes No Have You Ever Had Any Claims/Losses in The Last 6 Years? Either on Homeowners or Rental Property Insurance Policy? Yes No Date, Description, Amount of Loss ($)What Year Have You Had Continuous Property Insurance in Canada Since?What Year Have You Owned The Rental Home Since?Is The Rental Property Currently Insured? Yes No Name of Insurance CompanyRental PropertyPlease Answer Questions Below as They Pertain to Your Rental PropertyRENTAL PROPERTY Address(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Will A Single Unit Have More Than Two Unrelated Individuals Living in it? Yes No A Unit is defined as a space with its own separate entrance, bathroom and kitchen.Are Any Washroom or Kitchen Shared Between Units? Yes No Number of Mortgages on The Rental Property012Number of Units In The Property12345 or MoreA Unit is defined as a space with its own separate entrance, bathroom and kitchenYear BuiltThe Year The Rental Property Was BuiltHow Many Full Bathrooms?How Many Half Bathrooms?How Many Kitchens?How Many StoriesHow Many Square Feet (Excluding Basement)Is The Basement Finished? No Yes – 80-100% Yes – 60-80% Yes – 60%-40% Yes – 40% or less finished Is There a Sump Pump Pit? No Yes – There is a Sump Pump Yes – There is a Sump Pump with Battery Backup or Backup Generator Is There a Backup/Back Flow Valve Installed in the Home? No Yes Is There a Garage? No Yes – 1 Car – Detached Yes – 1 Car – Attached Yes – 2 Car – Detached Yes – 2 Car – Attached Any Detached Structures (Other Than Garage) Yes No Describe Detached StructuresAny Wood Burning Appliances? Yes No Such as wood burning stove, wood burning fireplaces. Rental Property – ConstructionDescribe the aspects of the property’s construction such as walls, roof, heating, plumbing and electricalExterior WallsWood Frame – Vinyl SidingWood Frame – With Brick or Stone Veneer Including Vinyl SidingMasonry Brick with Wood FrameSteelICFOtherDescribe Other:ElectricalCopper – 100AMP – BreakersCopper – 200AMP – BreakersCopper – 100AMP – FusesCopper – Less Than 100AMP – Breakers or FusesAluminum – 100AMP – Breakers or FusesMix of Copper and Aluminum with 100AMP or LessKnob and Tube Wiring With Mix of Aluminum or Copper – 100AMP or LessWhat Year Was The Electrical Updated?PlumbingCopper with Plastic DrainsPex with Plastic DrainsCast Iron with Cast Iron DrainsMix of Cast Iron, Pex and CopperKitec Plumbing with Plastic DrainsYear Plumbing Was UpdatedWhen all the plumbing was last replaced in the houseType of HeatingForced Air – Natural GasForced Air – PropaneForced Air – ElectricForced Air – PropaneHot Water / Steam – Propane, Natural Gas or ElectricWhat Year Was The Heating System Replaced?Hot Water Heater is: A Boiler Tankless What Year Was The Hot Water Heater Replaced?Type of RoofShingleMetalMetal / Shingle MixOtherOther Roof – Please Describe Type of RoofWhat Year Was The Roof ReplacedRental Property CoveragesAnuual Rental Revenue from the Property ($)Liability Insurance Limit $1 Million $2 Million More Rebuilding Cost of the Building ($)Consent(Required) I agree to the Privacy Policy and acknowledge the Disclosure Statement.Primary Residence – ConstructionBased on your above answers, you may qualify for a residential landlords policy as an extension from your homeowners policy. This could save you money. Below are a few questions on your primary residence which need to be answered to provide you with an accurate quote for both properties.PRIMARY Residence Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Is Any Part of Your Primary Residence Rented Out? Yes No Is It A Self Contained Unit? Yes No Number of Mortgages on Your Primary Residence012Year BuiltHow Many Stories ?How Many Full Bathrooms?How Many Half Bathrooms?How Many Kitchens?How Many Square Feet Excluding Basement?Is There an Alarm System? No Yes – Local Only (Does Not Ring to Central Station) Yes – Monitored for Burglarly Yes – Monitored for Burglary and Fire Is The Basement Finished? No Yes – 80-100% Yes – 60-80% Yes – 60-40% Yes – 40% or less finished Is There a Sump Pump It? No Yes – There is a Sump Pump Yes – There is a Sump Pump with Battery Backup or Backup Generator Is There a Backup/Back Flow Valve Installed in the Home? Yes No Is There a Garage? No Yes – 1 Car – Detached Yes – 1 Car – Attached Yes – 2 Car – Detached Yes – 2 Car – Attached Any Detached Structures? (Other Than Garage) Yes No Describe Detached StructuresAny Wood Burning Appliances? Yes No Such as wood burning stove, wood burning fireplaces.Your Primary ResidenceDescribe the aspects of the primary residence’s construction such as walls, roof, heating, plumbing and electricalExterior WallsWood Frame – Vinyl SidingWood Frame – With Brick or Stone Veneer Including Vinyl SidingMasonry Brick with Wood FrameSteelICFOtherDescribe – OtherElectricalCopper – 100AMP – BreakersCopper – 200AMP – BreakersCopper – 100AMP – FusesCopper – Less Than 100AMP – Breakers or FusesAluminum – 100AMP – Breakers or FusesMix of Copper and Aluminum with 100AMP or LessKnob and Tube Wiring With Mix of Aluminum or Copper – 100AMP or LessYear Electrical Was UpdatedPlumbingCopper with Plastic DrainsPex with Plastic DrainsCast Iron with Cast Iron DrainsMix of Cast Iron, Pex and CopperKitec Plumbing with Plastic DrainsYear Plumbing Was UpdatedWhen all the plumbing was last replaced in the houseType of HeatingForced Air – Natural GasForced Air – PropaneForced Air – ElectricForced Air – PropaneHot Water / Steam – Propane, Natural Gas or ElectricWhat Year Was The Heating System Replaced?Hot Water Heater is: A Boiler Tankless What Year Was The Hot Water Heater Replaced?Type of RoofShingleMetalMetal / Shingle MixOtherOther Roof – Please Describe Type of RoofWhat Year Was The Roof ReplacedPrimary Residence Property CoveragesBuilding CoverageAdditional CommentsUntitled
