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Entity Type:
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If you company is less than 3 years old, provide the name of previous Employer and period worked :
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Information About Your Business.
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Gross Annual Sales :
$
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Including all receipts- cost of material, labor and subcontractors
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Do you have written contracts with sub-contractors?
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Do these agreements contain a "Hold-Harmless" provision in the applicant's favour ?
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Current Insurance Information :
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No of years continuous insurance etc
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Coverage Requested
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Computer, Printer, Photocopier, Fax machine etc
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If your premises on rent and donot own the building
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Business Interruption Insurance Required $
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Is there any crime coverage required i.e theft of money and securities $
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Do you have Company Vehicles?
If yes and, needs quote, provide year, make and model of vehicle and driver's name, address, date of G2/G license taken in Ontario and number of years continuous claim free insurance experience etc in Remarks Column
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The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all. *
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