Rooming 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 Your Name First Last Your Contact Telephone Number*Your MAILING Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email Rooming House PropertyPlease Answer Questions Below as They Pertain to Your Rooming House Rental PropertyRooming House Property Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Have you Ever Had Any Claims/Losses in the Last 6 Years? Either on Homeowners or Rental Property Insurance PolicyYesNoDate, Description, Amount of Loss ($)Year BuiltHow Many Square Feet (Excluding Basement)Finished Basement? Yes No How Many StoriesSmoke/Fire Alarm On Each Floor? YES NO Number of BathroomsNumber of KitchensGarage No Yes – 1 Car – Detached Yes – 1 Car – Attached Yes – 2 Car – Detached Yes – 2 Car – Attached Any Detached Structures (other than garage) Yes No Please Describe Detached StructurePlease include what is used for, square footage and construction quality.# of Mortgages012Rental Property – ConstructionType of RoofWood – Ashphalt ShingleWood – SteelSteel DeckConcreteOtherUpdate Year*OtherElectricalCopperAluminumOtherOtherElectricalBreakersFusesAmps60 AMP100 + AMPUpdate Year*Type of PlumbingCopperPVCOtherOtherUpdate Year*Type of HeatForced Air GasElectricalOilOtherOtherUpdate Year*Is There a Signed Rental Agreement With Tenants YES – 12 MONTH CONTRACT Monthly Daily or Weekly None Property Currently Vacant? YES NO No Smoking Policy in Force? YES NO Cooking Allowed in Rooms? YES NO Is there a Swimming Pool? YES NO Does the owner live on premises? YES NO Are Meals Provided for Tenants? YES NO Have you been declined, refused or cancelled by another insurer? YES NO reason:Number of People Living in the House123456789101112+Who is Looking after the Property Property Owner Professional Management Company Friend and/or Relative Other Other Please DescribeAverage Age of TenantsWhat is the screening process for tenants?Check all that apply regarding tenants at this property Tenants working in blue collar trades: construction, factories Tenants are on government assistance such as ODSP Tenants are working professionals (I.T., Office) Tenants are all students in post secondary schools Tenants can include mix of all of the above Building Coverage Limit ($)Annual Rental Revenue from Property ($)Liability Insurance $ 2 Million Appliances Coverage $ 5,000 $ 10,000 $ 15,000 Sewer Backup Limit $10,000 $15,000 $25,000 $50,000 Additional CommentsFile UploadMax. file size: 40 MB.Although not necessary at this time, please attach anything that may help us in reviewing your property such as real estate listings, photos
