The Insurance Exchange - London Ontario Insurance

Home Insurance Quote

First Name:
Last Name:
Street Address:
City:
Province:
Postal Code:
Home Telephone Number:
Work Telephone Number:	ext
Email:

Type of Property

Home Owner

Condo Owner

Renting

Have you had any personal property claimed in the past 3 years?

Yes No

Have you had any cancellations for non-payment in the past 3 years?

Yes No

Age of Insured

Non-Smoker?

Yes No

Is your property located within 300 m (1000 ft) of a fire hydrant?

Yes No

Is your property located within 8 km (5 miles) of a fire hall?

Yes No

Policy Deductible Preferred:

Liability Amount Requested:

Estimated replacement value of personal property (condo and renters only)

FOR HOMEOWNERS ONLY

Present insured value

Estimated replacement value of dwelling

Morgage on Home

Yes No

Year Built

Square footage of Ground Floor

Type of Dwelling:

Construction of Dwelling

Percentage of Basement Finished:

Extra Bathrooms:

Central Air

Yes No

Porches:

Square Footage:

Deck

Yes No

Square Footage:

Garage type:

Size:

Woodstove

Yes No

Manufacturer:
Year Built:
Cords of Wood Per Year:

Type of Heat

Year Updated:

Type of Wiring

Year Updated:

Type of Plumbing

Year Updated:

Type of Roof

Year Updated: