If you are interested in having Clarke-Slighte Insurance provide you with a quote please provide the information requested below. By filling out the form you will help us to serve you better and faster.

Note: Homeowner's insurance is only available for Ontario residents. Note: all areas with * are required fields

 

All information will be kept strictly confidential and only used for the purpose of providing a quote.


Personal Details
*First Name *Last Name
*Age (may qualify for age discount)
Address
*City
Province Ontario
*Postal Code
*Day Phone
Evening Phone
E-mail Address  

Policy Information
Do you currently have a policy in force? Yes No
If Yes, what is the expiry date of the policy?

Location Details
Yes No Not sure
Is there a fire station within 8km of the location?
Is there a fire hydrant within 300 meters of the location?
Do you have a centrally monitored fire alarm system installed at the location?
Do you have a centrally monitored burglary alarm system installed at the location?

Homeowner Questions
What year was your home constructed?
What is the current estimated value of you home?
What is the square footage of you home? sq feet
What material is the exterior of your home constructed from?
Do you rent out a portion of your home? Yes No
If Yes, how many rental units are there?
Do you operate a business from your home? Yes No
(If yes please list in the Additional information section)
Structure type?
Occupancy type?

Coverage Required
What deductible would you like for your home owners policy?
Current Dwelling Limit Replacement Cost Included? Yes No
Current Contents Limit Replacement Cost Included? Yes No
Extensions/Addditional Riders Yes No
Please specify details in the Additional information section.
What amount of liability insurance do you want?

Claim History
Have you made any claims on your previous habitational insurance policies in the last 5 years? Yes No
Description of Claims
Date of claim Cause Amount

Additional Information
Please enter any additional information that you think may assist us in providing you with a faster and more accurate quote.

How did you hear about us?
(eg. yellow pages, referral, search engine, etc.)

Thank you for filling out the form!