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Residential Landlord 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

Your Name
First Last
Your Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Contact Telephone Number
Email
Your Date of Birth
Do you have a home or condo insurance policy on your primary residence?
- Yes
- No
Have you had home insurance for over 3 years?
- Yes
- No
Do you Live in the Rental Property?
- Yes
- No
Rental Property
Please Answer Questions Below as They Pertain to Your Rental Property
Number of Units in Property
Occupants in Each Unit Same Family
Are Any Washroom or Kitchen Shared Between Units
Total # of Tenants in Property
Is the Rental Property Currently Insured?
- Yes
- No
Name of Insurance Company Currently Insured With*
Policy Number (optional)
Have you Ever Had Any Claims/Losses in the Last 6 Years? Either on Homeowners or Rental Property Insurance Policy
Date, Description, Amount of Loss ($)
Rental Property Address
Street Address City Province Postal Code
Firehall within 8KM
Fire Hydrant within 150M
# of Mortgages
Year Built
How Many Square Feet (Excluding Basement)
How Many Stories
Burglar Alarm
- None
- Local Alarm
- Monitored Alarm
Smoke/Fire Alarm in each unit?
- None
- Local Alarm
- Monitored Alarm
Sprinklered
- Yes
- No
Finished Basement?
- Yes
- No
Garage
- No
- Yes - 1 Car - Detached
- Yes - 1 Car - Attached
- Yes - 2 Car - Detached
- Yes - 1 Car - Attached
Any Detached Structures (other than garage)
- Yes
- No
Please Describe Detached Structure
Please include what is used for, square footage and construction quality.
Rental Property - Construction
Type of Roof
Update Year*
Other
Exterior Walls
Other
Electrical
Other
Amps
Electrical
Other
Type of Plumbing
Other
Type of Heat
Other
Type of Air Conditioning
Other
Annual Rental Revenue from Property ($)
Liability Insurance
- $ 1 Million
- $ 2 Million
Appliances Coverage
- $ 5,000
- $ 10,000
- $ 15,000
Rebuilding Cost of Building ($)
Your Primary Residence
Based 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.
Primary Residence Address
Street Address City Province Postal Code
Name of Current Insurance Company
Construction Details
Year House Built
Year Built
Fire Hydrant within 150M
# of Mortgages
Square Feet (Excluding Basement)
How many stories
Burglar Alarm
- None
- Local Alarm
- Monitored Alarm
Smoke Alarm Each Floor?
- None
- Local Alarm
- Monitored Alarm
Finished Basement?
- Yes
- No
Garage
- No
- Yes - 1 Car - Detached
- Yes - 1 Car - Attached
- Yes - 2 Car - Detached
- Yes - 1 Car - Attached
Any Detached Structures
- Yes
- No
Please Describe Detached Structure, Square Footage and Construction
Type of Roof*
Update Year
Other
Exterior Walls*
Other
Electrical*
Other
Ampage
Electrical
Other
Type of Plumbing
Other
Type of Heat
Other
Type of Air Conditioning
Other
Liability Insurance
- $ 1 Million
- $ 2 Million
Building Coverage
Additional Comments

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