Student 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. Your Name First Last Your MAILING Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Your Phone Number(Required)Your Email Student Rental Property Address(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Construction & Property DetailsYear Property Was Built(Required)How Many StoriesNumber of Kitchens in The PropertyNumber of BathroomsNumber of BedroomsIs The Basement Finished? Yes No Is There a Swimming Pool? Yes No Any Detached Structures? Yes No Is There A Wood Burning Appliance in The Property? Yes No Smoke Alarms and Carbon Monoxide Detector on Each Floor? Yes No Does The Basement Have A Separate Entrance? Yes No Does The Basement Have Egress Windows? Yes No Is The Property Designated as Heritage Yes No Type of RoofAshphalt ShinglesMetalFlat Roof (e.g., Rubber, TPO, or EPDM)Synthetic/Composite (e.g., Plastic, Rubber Composite)Other (Specify)Update Year of RoofYear Roof was Last UpdatedOther Roof – Please SpecifyElectrical – Wiring TypeCopperAluminumMixElectrical – Panel TypeBreakersFusesMixElectrical – Panel AMPS100 AMP200 AMPMore Than 200 AMPLess than 100 AMPUpdate Year of ElectricalYear Electrical Was UpdatedType of Plumbing?Copper or Pex (Supply) with 100% Plastic (Waste)OtherUpdate Year of PlumbingYear Plumbing was UpdatedOtherPlease Describe Plumbing Supply Pipes and Drains TypeType of Heating?Forced Air – GasHot Water/Radiator – GasBaseboard ElectricHeat PumpOtherUpdate Year of HeatingYear Heating was UpdatedType of Hot Water HeatingBoiler TankInstantaneousYear of Hot Water TankYear Hot Water Tank or Boiler Was ReplacedOperation DetailsNumber of Students Living in The House?How Many Students Live in the Basement?How Many Students Live on The Main Floor?How Many Students Live on The Second Floor?How Many Students Live on Floor(s) Higher Than Second Floor?Is The Property Currently Vacant? Yes No Cooking Allowed in Rooms? Yes No No Smoking Policy in Force? Yes No Who Looks After the Property? Property Owner / Landlord Management Company Friend / Relative Other How Often is Property Inspected? Monthly Annually Quarterly As Needed Year Your Purchased the PropertyHow Many Mortgages Are There?Do You or A Family Member Also Live in The Property ? Yes – I Live in The Property Yes – One or More of my Children Yes – Other Relative No Is There a Signed Rental Agreement with Each Tenant? Yes – 12 Months Yes – 8 Months No Is The Mortgage with a Standard Financial Institution Like a Bank or Credit Union? Yes No Current Insurance Company NameEnter the name of the Current Insurance Company or Simply Write New Purchase if You Are Just Purchasing The PropertyHave you Ever Had Any Claims/Losses in the Last 6 Years? Either on Homeowners or Rental Property Insurance PolicyYesNoDate, Description, Amount of Loss ($), Is the Claim Closed?Has an Insurance Company Ever Cancelled one of Your Policies?NoYesPlease Describe Why The Policy Was CancelledWhat Effective Date Would You Require For This Property? MM slash DD slash YYYY Coverages Required:Building Coverage Limit ($)Protects the physical structure of the student rental property itself against covered events. Coverage is either on a Named Perils Form or a Broad Form followed by a basis of settlement either Actual Cash Value or Replacement CostCommercial General Liability Insurance $1 Million $2 Million More Protects landlords against claims for third-party bodily injury or property damage occurring on the rental property. Such as a tenant or visitor slipping and falling on icy steps.Detached Structures (Optional) Not Required Detached Structures ($)Detached structures like garages or sheds are not automatically covered unless explicitly listed on the policy. Coverage for detached structures mirrors the building coverage terms offered, including Named Perils or Broad Form.Equipment – Appliances (Optional) Not Required Equipment – Appliances ($)Appliance coverage includes physical damage coverage to the appliances itself, the same as the building such as fire damage. It does not provide replacement for wear and tear. Business Interruption – Rental Income(Optional) Not Required Business Interruption – Rental Income ($)Covers loss of rental income if the property is damaged by a covered event (e.g., fire) and becomes uninhabitable. Key details include: •Coverage is limited to time to repair or maximum of one year and limit. • Does not pay for tenants to relocate for that tenants must have their own insurance for additional living expenses. •Only applies to insured perils (ex: fire). Does not cover tenant default. •Relatively Inexpensive Coverage for Coverage Provided Flood Coverage (Optional) Not Required Flood Coverage Yes – Please Quote Provides protection against damage caused by rising bodies of water (e.g., overflowing rivers). This does not cover seepage, leaks, overland & surface water or gradual water damage. Usually has a higher deductible.Earthquake Coverage (Optional) Not Required Earthquake Coverage Yes – Please Quote Coverage for damage caused by earthquakes. Usually has a higher deductible.Sewer Backup Coverage (Optional) Not Required Sewer Backup Coverage Yes – $25,000 Limit Yes – $50,000 Limit Yes – $100,000 Limit More Covers damage caused by backups from basement drains or sump pump overflows. Excludes: • Water entering through windows or doors. • Also Excludes: Overland water (rain or snowmelt flowing above ground), which is not offered on commercial policies for student rentals. Overland water may be available on personal homeowner policies but is typically excluded from commercial ones. Vandalism or Malicous Acts by Tenants or Guests (Optional) Not Required Vandalism or Malicous Acts by Tenants or Guests Yes – Please Quote Covers vandalism by tenants or their guests. This is typically excluded on rental property policies, but may be offered by some companies and rental properties. Carries higher than normal deductibleAdditional CommentsConsent(Required) I agree to the Privacy Policy and acknowledge the Disclosure Statement.
