HOMEOWNERS “QUICK QUOTE” QUESTIONNAIRE
Name:______
Address:______postal code: ______
How would you like to be contacted with the quote?
email: ______ Phone:______Fax:______
Dwelling year built: ______
Estimated Replacement Value of Dwelling: $______(The cost to rebuild your home today including labour, materials, bylaws, etc. If you do not know, please provide the total square footage of your home or an exterior photo and we will estimate the value).
**IF YOUR HOME IS OVER 25 YEARS OLD, PROVIDE DETAILS OF WHEN THE Heating, Wiring, Plumbing or Roof HAVE BEEN PARTIALLY OR FULLY UPDATED OR REPLACED. Updating of these features may result in preferred insurance rates and coverage.
Home Inspection done? If yes provide a copy.
Major Renovations? Describe details of renovations and date completed:
Any oil tank on the property (above or below ground)?
The following questions apply to discounts which may be available to you.
SECURITY: Burglar Alarm: Monitored_____ Local_____ Fire Alarm: Monitored_____ Local_____
Block Watch:____ Interior Sprinkler System____ Number of Smoke detectors: ______
Firehall within 8 km: Yes____ No_____ Fire Hydrant within 300 metres: Yes_____ No______(all homes in the Lower Mainland are within range)
OCCUPANCY: Owner-Occupied?______No. of Families in Dwelling______Any part rented out?_____ Any roommates? ______
Are all occupants in the house “non-smokers”? yes: ____ no:____
Any Business conducted on Premises?______If yes, type of business______
Have you carried home insurance in the past? ______If so, how many years?
Any losses/claims in past 5 yrs? Yes: ___ No: ___ if yes, provide Date of Loss, Details of Claim & Amount Paid by Insurer: ______
Have you ever had your insurance cancelled or been declined insurance? If so, please describe: ______
Any Mortgage or Line of Credit on the house? Yes: __ No: __ (if no, a discount will apply)
Is any owner/occupant of the home over the age of 45? If so, please provide age or birthdates: ______
Some insurers offer discounts based on your occupation; please advise your occupation and place of employment:______
Call, Fax or email this information to us and we will provide you with a rough quote within one business day.
KAMI INSURANCE AGENCIES LTD. 200-678 West Broadway, Vancouver, BC V5Z 1G1 ph: 604-876-7999 fax: 876-7909 email: