Home Insurance Quote

If you would like a quote for Homeowner’s Insurance (including owner-occupied homes, seasonal homes, or rental homes), please complete our questionnaire below. Alternatively, you may download and fill out the PDF version of the form, then email the complete form along with photos to: office@underwriterspr.ca. Please allow 2-3 business days for a reply. You can find the PDF version of the questionnaire in our downloadable forms here.

The information that you provide in this questionnaire will be used to determine your premiums and eligibility for insurance, and you are responsible for the accuracy of the answers you provide. 

• If you falsely describe or fraudulently omit any fact that is material to the insurance company in order for it to be able to judge the risk, your insurance policy may be void.
• Please ensure that you fully understand the answers that you are providing when completing this questionnaire; if you are unsure of some of these details, we strongly recommend that you obtain professional advice.
• You are welcome to contact our office with any questions you have about this questionnaire.

Please note, email is not a secure method of transmitting sensitive personal information and by using this service you accept this risk. If you are concerned, you may use an alternative method.

This request form will take 10-15 minutes to complete and includes four sections.

Please enable JavaScript in your browser to complete this form.

– Step 1 of 4

ABOUT THE APPLICANT(S)

Name *

First

Last

Address of dwelling *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Phone *

Email *

Email

Confirm Email

Date of Birth *

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Occupation *

Are there any other applicants? *

• Yes
• No

Name of other applicant *

First

Last

Date of Birth of other applicant *

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Occupation of other applicant *

Have you ever been cancelled, declined, or been refused renewal of insurance? *

• Yes
• No

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

• Yes
• No

Date of the loss *

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Dollar amount of the loss *

Type of claim *

Do you currently have an insurance policy in force? *

• Yes
• No

What is the policy number and insurance company name? *

Please provide: (1) the insurance company name and policy number of your most recent insurer, and (2) how many years you have been continuously insured without any gaps.

What is the expiry date of your current or most recent habitational insurance policy: *

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Next

ABOUT THE HOUSE TO BE INSURED

Will you have a mortgage/loan on this property? *

• Yes
• No

Do you have MONITORED fire or burglary alarm system installed? *

• Fire & Burglary*
• Fire Only
• Burglary* Only
• No

*Alarm certificate from monitoring company may be required*

How many smoke detectors do you have, and what type? *

Do you have an auto-shut off / water leak detection system? *

• Yes
• No

What is the occupancy of the home?Primary residenceSeasonalRentedVacant

Are there ANY Farm / Business activities on the premises? *

• Yes
• No

Will you have any roomers or boarders? *

• Yes
• No

Would you like us to include a discount based on a soft credit check? *

• Yes
• No

Are there any deficiencies to the condition of the property? *

• Yes
• No

Please describe deficiencies: *

PHOTO REQUIRED (front & back)* *

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

*2MB maximum size per photo. File types: JPG, PNG

What year was the house built? *

Were the house plans: *

• Architecturally designed
• Standard plans
• Don’t know

What type of construction is the building? *— Select Choice —Regular Wood FrameLog HomeConcrete/MasonryFire ResistiveOther

APPLICANT(S) What value:

What is the fire protection in your neighborhood? *— Select Choice —Fire Hydrant within 300m & responding Fire Hall within 8kmResponding Firehall within 13km, but NO hydrant within 300mNo responding firehall within 13km

How many stories is the house? *— Select Choice —bi-level1 storey with basement1 & 1/2 storey2 storey

What type of foundation does the house have? *— Select Choice —full basementcrawlspaceslab

Is the foundation full/continuous? *

• Yes
• No

Is the basement fully finished? *

• Yes
• No

What percentage of the basement is finished? *

Are there any additional suites in the home? *

• Yes
• No

Does the suite include any of the following (check all that apply): *

• Kitchen
• Separate entry/exit

What is the square footage PER FLOOR of the house: *

What is the total square footage of the house? *

How many bathrooms *— Select Choice —12345678910

How many fixtures are there for each bathroom? *

What type of floor coverings? (Estimate % of each type please) *

What type of roofing? *— Select Choice —Asphalt shinglesCedar shakesMetalCeramicOther

If there are any deficiencies in the roof (moss, debris, worn shingles), please describe:

What year was the roof replaced? *

PreviousNext

PLUMBING, HEATING & ELECTRICAL DETAILS

What is the plumbing material (check all that apply)?

• Copper
• PEX
• Galvanized
• Iron
• Poly-B
• Other

What year was the plumbing updated? *

Was the plumbing update: *

• Partial update
• Full update
• Don’t know

What is the age of the hot water tank in years? *

What type of hot water tank? *— Select Choice —ElectricNatural gasPropaneSolarOther

What is your primary heat? *— Select Choice —Electric Baseboard/Wall Fan UnitsCentral FurnaceHeat PumpWall FurnaceHot Water Radiant (Boiler)Radiant in-Ceiling Electric PanelsWood/Solid FuelMasonry HeaterPortable Space HeatersOther

Do you have any secondary/auxiliary heat? *— Select Choice —NoneGas/Electric FireplaceWood/Solid Fuel StoveSolid Fuel Fireplace InsertConventional Wood Fireplace (no insert)Masonry HeaterElectric Baseboard/Wall Fan UnitsFurnaceHeat PumpOther

Are all heating appliances certified (CSA/ULC approved)? *

• Yes
• No

Were the house heating system(s) professionally installed? *

• Yes
• No
• Don’t know

When were the heating system(s) updated? Was it a full or partial update? *

Are there any oil tanks on the property (in use or decommissioned)? *

• Yes
• No

Is the oil tank single or double-walled/bottomed? *

• Single
• Double
• Don’t know

What is the electrical service? *— Select Choice —100 amp125 amp200 ampOther

What type of wiring (check all that apply)? *

• Copper wiring
• Aluminum / knob & tube
• Fuses
• Other

What year was the wiring updated, and was it a partial or full update? *

Is there an air-conditioning system installed? *

• Yes
• No

Are there interior fire sprinklers built in? *

• Yes
• No

Do you have any fireplaces? *

• Yes
• No

Do you have a woodstove / fireplace insert? *

• Yes
• No

Is the woodstove / fireplace insert inspected, labeled and approved? *

• Yes
• No

PreviousNext

OTHER FEATURES OF THE HOUSE

What is the exterior cladding material and the percentage of each material? *

Regular 8 foot ceilings, or are there any vaulted ceilings? (Please indicate the percentage of each please) *

Is the front door (check any that apply):

• Single door
• Double door
• Has sidelight panels

If there are any PORCHES, indicate whether they are open or closed, and the total square footage (IF NONE, type in "not applicable"): *

If there are any SUNDECKS or PATIOS, indicate the total square footage (IF NONE, type in "not applicable"): *

Are there any garages or carports? *

• Yes
• No

Add more carports or garages by clicking on the “+ Add” icon below.

Is the garage or carport: *

• Attached
• Detached

How many cars: *

• 1
• 2
• 3 or more

Add Remove

Are there any pools? *

• Yes
• No

Size of pool *

Type of pool

• Above ground
• In ground

Are there any hot tubs? *

• Yes
• No

Size of hot tub *

Type of hot tub *

• Built in
• Free standing

Are there any sky lights? *

• Yes
• No

Size of sky light *

Do they open? *

• Yes
• No

Are there any sunrooms or solariums? *

• Yes
• No

Square footage or sunroom or solarium: *

Are there any built ins? (check all that apply)

• None
• Dishwasher
• Central vacuum
• Wall oven
• Jetted tub
• Other

Are there any custom features? (check all that apply) *

• None
• Granite counters
• Custom trim / finishes
• Other

What is the value of any custom features? *

Are there any Building Bylaws issues that would affect your ability to rebuild? *

• Yes
• No
• Don’t know

Do you have any items of particular value that you wish to insure as a specific, scheduled item? *

• Yes
• No

* Some people have items such as jewellery, fine arts, sports equipment, or other items of higher value that they require additional insurance or increased limits for. Please notify us if you have any items that are of particular interest or value to you. If so, please state each item and its value here.

What are the items and their estimated value? *

Do you have any other information that is not listed above? *

• Yes
• No

Please specify what it is and the value: *

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