Condo and Townhouse Form | Bicycle Broker Insurance

First Name *

Last Name *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Date of birth of owner *

Expiry of existing policy or desired effective date: *

Use of the property *

List all owners of the property *

What kind of building is this? *

How many years have you carried condo/home insurance? *

Do you consent to a soft credit check? This does not impact your credit score. *YesNo

Year condo was built *

Do you have a mortgage on the property? *

Who is the mortgage with? (Bank name, branch, office address) *

Does the property have an alarm system? *

Year your condo was built? *

Limit of Liability requested? *

Deductible Requested? *

Condo protection limit *This covers loss assessment, unit improvements, betterments, and contingency coverage.

Condo Protection Deductible *

Contents limit (Up to $150k) *

Would you like Sewer back up coverage? *YesNo

Would you like water protection coverage? *YesNo

Would you like to add any bikes or jewellery? *YesNo

Would you like Earthquake coverage? *YesNo

Have you had any claims in the last 5 years? *YesNo

If yes, please provide a description, including dollar amount paid or held in reserve? *

Has the applicant ever been declined or cancelled by an insurance company? *YesNo

Is the condo a seasonal, secondary or vacant property? *YesNo

Is this condo a part of a bare land condo or cooperative housing? *YesNo

Does this condo have a solid fuel heating system? *YesNo

Are there any farming operations or daycare or business run out of this location? *YesNo

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Condo & Townhouse Form

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