Vacant Land Name(s) of all person(s) who own this property: Your MAILING address: Your email address: Address of insured property: Street Address Best Phone number to call you back at:How many years have you owned this property? or date purchased? Which date do you require insurance on this property? MM slash DD slash YYYY Any claims in the last 5 years? If yes, please state date of loss, amount paid out by ins. company and briefly outline what happened.If you have a current insurance policy on this location, please send first few pagesMax. file size: 10 MB.File must be 10 MB or less Please send us a photo of your homeMax. file size: 10 MB.File must be 10 MB or less Approx. how long will this property be vacant? less than 1 month 1 month to 3 months 3 months to 6 months 6 months to One year What are the future plans for this property? use property for personal pleasure use only rent out the property to others. hold property and sell at a future date Any rivers, lakes and or streams running through property Yes No Is this property within 300 meters of a fire hydrant & within 8kms of a manned firehall? Yes No Do you have a registered mortgage on this home? Yes - with a Bank in Canada Yes - with a private lender No - this property is clear title I have a credit line on this home and the bank does NOT need to be named on the policy. List any structures below and what they are being used for? Is the property fenced? If you will be renting out this property to others, what will they be doing on the property? Is this property on agricultural farm land? Yes No Will there be any animals kept on this property? Yes No How did you find out about our office? I have an existing home policy with your office. I was referred by someone. I found you via google search. I noticed your office when I was driving/walking by. I am a personal client of one of your producer/ staff members. I am an existing auto insurance customer. NameThis field is for validation purposes and should be left unchanged.
