Home Evaluation Form

* First Name

* Last Name

* Phone Number

* E-mail address

Policy Number (if available)

* Full Address of Property for Home Evaluation

Please fill out the questions below and click the Submit button when finished. You can also save your partial entires and return to this form at a later date by creating a login identification and password at the bottom of this page.

* Square Footage of Total
Living Area (excluding basement)

* Year Property Built

* Type of Structure

* Construction Quality of Home

* Physical Shape of Home

* Exterior Siding

Vinyl siding	Stucco
Wood siding	Other (please specify)

* Roof Material

* Number of Bathrooms (excluding basement)

Full
Half

* Has the home been completely
gutted in the last 40 years?

* Does the property have a garage?

If yes, is the garage attached or detached?

Attached

Detached

If you have a garage, how
many cars is the garage?

1 car	2 cars
3 cars	4 cars

If garage is detached,
indicate year it was built

* Is there a bonus room
above the garage?

No

Yes, Estimated square feet is

* Do you have a porch?

No

Yes, Estimated Square feet is

If you have a porch, is it
enclosed or open?

* Do you have a deck?

No

Yes, Estimated Square feet is

What type of material is the deck?

* Is the basement developed?

Fully

Partially

None

* Is your basement a walk-out?

* Estimated total square
feet of basement

Estimated square feet of
basement that is developed

* Do you have a balcony?

No

Yes, Estimated Square feet is

* Type of foundation:

Poured Concrete

Other (please specify)

Does the property have a free standing wood burning stove?

Do you rent a room or suite in your house?

Do you have a home based business? If so, please specify (e.g. accounting/dayhome/music lessons etc)

No	Yes, please specify

Do you have an extensive amount of jewellery/fine arts/furs/hearing aids/watercraft that you feel should be specifically covered under your policy?

No	Yes, please specify

* Do you currently have a mortgage on your house?

* Does the property currently
have an alarm system?

If yes, is it locally or centrally monitored?

Local

Central

* Does the property have
water sensors?

* How many years have you
lived at this current location?

* How many continuous years have
you had property insurance for?

* Have you had any property claims in the
last 10 years? If yes, please indicate the
date of the last claim (MM/YY).

No	Yes, Date of last claim was (MM/YY)

* Is your home within 300 metres of a fire hydrant?

* Is your home within 13 km of a fire hall?

* Is your hot water heater tankless?

* Do you have a sump pump?

No	Yes, Date of installation (MM/YY)

* Do you have a back water valve?

No	Yes, Date of installation (MM/YY)

Please provide the following for each named insured

* Full Name

* Date of Birth (MM/DD/YYYY)

* Occupation

Employer

Full Name

Date of Birth (MM/DD/YYYY)

Occupation

Employer

If your house was built BEFORE 1995, please answer the following questions on Type of Plumbing, Wiring, Heating & Electrical Service. Otherwise, you can skip this section.

Type of Plumbing

Copper

Plastic

Galvanized

Type of Electrical Wiring

Copper

Aluminum

Type of Electrical Service

Breaker Box

Fuses

How Many Amps is the electrical?

60

100

over 100

Year the Electrical Wiring
was upgraded or replaced.

Year your furnace
was last replaced?

When was your furnace last
professionally inspected and serviced?

What year was your
roof last replaced?

What year was your water
heater last replaced?

Combining your Auto insurance with Home Insurance can give you SIGNIFICANT savings. Please enter your auto information below and we will be glad to also provide you a quote on your Auto insurance.

Gender

Vehicle Type

Vehicle Model

Number of Doors

Vehicle Year

Vehicle Use

Pleasure

Driving to and from work

Annual Kilometres Driven

Number of One Way Kilometres To Work

Formatted Text

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* Indicates Response Required

Asphalt Shingles	Clay Tile
Wood Shingle/Shakes	Cedar Shakes
Concrete Tile	Other (please specify)