condominium unit owner
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| Name: (optional) |
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| Address: (optional) |
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| Email address: |
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| Telephone: |
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| Fax: |
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| Current policy expiry date: dd
mm
yr
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| Within 300m of a fire hydrant: |
yes
no
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| Within 8km of a fire hall at: |
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| Year home built:
single family dwelling yes:
no
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| Any special alarm systems: |
yes
no
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| If yes, is it monitored for burglary and fire: yes
no
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if yes, please describe:
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| Any commercial use of the premises, from incidental home office use to home business: yes
no
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If yes, please describe:
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| Are any rooms rented out: |
yes
no
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| Have you had insurance for at least the past 3 years: yes
no
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| Have you had any claims: |
yes
no
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If yes, please advise dates, type of claim and approximate amount paid:
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| Ages of owners: |
and
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For package comparison, please complete the following from your current policy or from your renewal quotation:
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| OPTIONAL COVERAGES: |
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| Do you have any other items included on your current policy, such as: |
| Earthquake on Dwelling and Contents: yes
no
deductible
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| Broad Form Water Escape: yes
no
deductible
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| Scheduled items, such as jewelry: yes
no
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if yes, please specify:
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Liability extension? If yes, please describe:
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Any other Options? Please describe:
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| Current Premium (optional): |
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If you have any questions at this time or feel there is anything else we should know that might effect the insurance, please advise:
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| Click here to send this form to Seafirst Insurance Brokers:
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| Thank you for taking the time to complete the quotation request. We will respond as soon as possible. |
