Student Residence Insurance Quote

Please complete this form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to a sales representative, please call us at 416-728-6806.

NAME OF INSURED
MAILING ADDRESS ((If different from Location Address)
MAILING ADDRESS ((If different from Location Address)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
LOCATION OF RISK LOCATION OF RISK
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
PRINCIPALS (if in a company name)
MORTGAGEES (name & address in payment order):
Phone Phone - ### - ### ####
Email
Building Details
FIRE PROTECTION: Hydrant:
Within 300m?

FIRE PROTECTION: Hydrant:
Within 300m? Yes No
Fire Hall: Within 8km?

Fire Hall: Within 8km? Yes No
Fire Hall:

Fire Hall: Paid Volunteer
CONSTRUCTION:

CONSTRUCTION: Brick Frame Stone Masonry Log Others (Please Describe in Remarks)

Please Describe in remarks
Foundation

Please choose one
AGE OF BUILDING

Year of Built
NO. OF UNITS
NO. OF OCCUPANTS
NO. OF STORIES
Is each unit a self-contained suite?

Is each unit a self-contained suite? Yes No
Does property have fire extinguishers? ?

Does property have fire extinguishers? ? Yes No
Operable smoke detectors?

Operable smoke detectors? Yes No
Operable sprinklers?

Operable sprinklers? Yes No
ELECTRICAL SYSTEM:

ELECTRICAL SYSTEM: 60AMP 100AMP 200AMP Circuit Breakers Fuses Aluminum Wiring Knob & Tube Wiring ( Describe location in remarks)

Please describe location in remarks
PLUMBING (type):
AGE OF ROOF :
If Oil is used, needs more information about Tank and photos of oil tank(s)
Does property have a central heating system?

Does property have a central heating system? Yes No
Is there a solid fuel heating unit?

Is there a solid fuel heating unit? Yes No
UPDATE INFO ELECTRICAL (YEAR):

If age of building is more than 20 years old, then updates required
UPDATE INFO HEATING (YEAR):

If age of building is more than 20 years old, then updates required
UPDATE INFO PLUMBING (YEAR):

If age of building is more than 20 years old, then updates required
UPDATE INFO ROOF (YEAR):

If age of building is more than 20 years old, then updates required
Number of Occupants
Number of Units
Are there any Hot Plates?

Are there any Hot Plates? Yes No
Any cooking in rooms?

Any cooking in rooms? Yes No
How many rooms are vacant at present?
Is there a No Smoking policy in place and enforced?

Is there a No Smoking policy in place and enforced? Yes No
How many Common (shared) kitchens?
How many Common (shared) Bathrooms?
How many Common (shared) Bathrooms?
Is there a swimming pool on the premises?

Is there a swimming pool on the premises? Yes No
Is there a live-in â€œManager/Caretakerâ€??

Is there a live-in â€œManager/Caretakerâ€?? Yes No
If Yes Name of Manager/Caretaker: Unit/Apt. No:
Who is responsible for dwelling maintenance?
How often is property inspected?

Weekly / Monthly/ or
Previous Insurer:
Policy Number
Expiring Premium:
Renewal offered?

Renewal offered? Yes No
If Renewal not offered , please explain
Five (5) Year Loss history (date; paid/estimated amount; cause; open/closed)?
LIMITS OF INSURANCE : Building $ Dollars . Cents
Contents (appliances only): $ Dollars . Cents
Rental Income: $ Dollars . Cents
Liability (OL & T):
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.

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. I Agree

Student Residence Insurance Quote

Student Residence Insurance Quote

Building Details