To receive a free no obligation quotation, simply fill out all of the required fields.  An estimation of your premium will be e-mailed back to you within the next 48 hours.

The following forms are for quotation purposes only and they are not to be considered as an application for insurance nor a policy of insurance.

 

Name: E-mail: Renewal Date:
Province: Ontario City: Postal Code:
Telephone:

Best time to be contacted: Monday Tuesday Wednesday Thursday Friday 

9am-12pm  12pm-4pm 4pm-7pm

Driver ages: 

#1  

#2  

#3    

#4  

Marital Status:  #1   #2   #3    #4
Gender:

:

#1 #2 #3 #4
Years Licensed in Ontario #1

#2

#3

#4

Vehicle Information:
Model Year #1 #2 #3 #4
Make (Ford, Chev, etc.) #1 #2 #3 #4
Model (Caravan, Escort, etc) #1 #2 #3 #4
# of cylinders #1 #2 #3 #4
Body type of Car #1  #2  #3  #4 
Body type for hatchbacks #1  #2  #3  #4 
Coverage Section
Liability: (none signifies coverage not required)
#1 #2 #3 #4
Collision Deductible: (none signifies coverage not required)
#1 #2 #3 #4
Comprehensive Deductible: (none signifies coverage not required)
#1 #2 #3 #4
Specified Perils: (Fire & Theft) instead of above
#1 #2 #3 #4
Endorsements:
#1 #2
#3 #4
Vehicle Use 
#1 #2
#3 #4
Occasional Operators
#1

#2

#3
All occasional operators have driver training:  yes no
What license do operators have:
# of years licensed:
Present insurance company: # of years insured:
Has any insurance company cancelled automobile insurance in the last three years:  yes no
Has any of the drivers had a license suspension or been cancelled in the past six years:  yes  no
If yes, give details:
During the last 3 years, has any automobile insurance policy issued to the applicant or driver been cancelled or had a claim denied for material misrepresentation:    yes no
If yes, give details: 
Has any applicant or driver been found by a court to have committed a fraud connected with automobile insurance: yes no
If yes, give details:
Give details of all convictions of the applicant and any drives arising from the operation of any automobile in the last three years:
Have you or any drivers in the past six years had any accidents:
An not at fault accident: yes no An at fault accident: yes no
If yes, please give the following details for each claim:
Date of loss: Which driver: Amount of claim:
Details:

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