Rate Comparison for Personal Insurance

* required information
If you currently have an insurance policy and would like to find out if you are getting the best premium, please complete as much information as possible in the form below and we will provide you with a rate comparison with six different insurance companies using the information you provide.

Name*:
Address*:
City*:

Province (principal residence must be in Manitoba):
Postal Code*:
Protection*:
Type of Construction*  (condo & tenant only)
Daytime Phone Number:

Fax Number:
E-Mail Address:
Preferred Method of Contact*:

If by phone, specify best time to call
COVERAGES
Type of Insurance*:
Type of Package*: click here for definitions
Policy Deductible*:
Dwelling (Homeowners Only)*: $
Detached Structures (Homeowners Only)*: $
Personal Property/Contents*: $
Personal Liability*: $

Updates to Dwelling (Homeowners Only)*:

(Please provide information to the best of your knowledge)

What is the age of your house? 

How old are your shingles? 

Do you have circuit breakers or fuses?

What type of plumbing to you have (copper, galvanized or PVC)?

What type of heat is in your house? 

How old is your heating system? 

Discounts*:

(choose all that are shown on your current policy)

How long have you had insurance? years

Are you claims free?  yes   no

       If yes, how many years? 3 years  5 years

How long have you lived at this location? 

Do you have a mortgage?    yes   no

What is your birth date? 

Does your house have an alarm:  fire  burglar

                                                       

Optional Coverages*:

(choose all that are shown on your current policy)

Sewer Backup: 

Reduced Glass Deductible:   

Personal Articles Floater

        $ 

        $ 

        $ 

Other

        $ 

Effective Date of Current Policy: (mm/dd/yyyy)
Additional Comments:

Disclaimer:  This is a request to provide a quote only and is not an insurance policy. It is not an offer of insurance. Further information may be required in order for a complete quote to be provided. This quote request contains some information about coverage offered but it does not list all of the conditions and exclusions that apply to the described coverage. The actual wording of the policy governs all situations.  This quote request is only available to persons resident in the Province of Manitoba.  The products described are subject to change without notice at any time.