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Auto Quote
Additional Driver %#% Information
| Gender : Male Female |
| Marital Status : Married Single |
| If licensed for less than 6 years, did you complete an approved Canadian driver training course? Yes No Not Applicable |
| Have you had your drivers licence suspended, revoked, or cancelled in the last 6 years? Yes No |
| If yes, indicate reason and length of suspension. |
| Have you had any accidents, claims, or convictions (including seat belt fines) in the past 10 years? Yes No |
| If yes, describe and note date. |
| How many non-accident insurance claims (like theft or windshield claims) have you made in the past 6 years? If applicable, please indicate date and type of claim. |
| Have you been listed as a driver on an insurance policy (Canada or US)? Yes No |
| If yes, for how long? |
| Have you had any lapses of insurance in the last 10 years? Yes No |
| In the last 3 years, have you had a policy cancelled by an insurance company? Yes No |
| If yes, indicate reason: |
Additional Vehicle %#%
Additional Vehicle %#% Information
| Who is the primary driver of this vehicle? | |
| Is there an Occasional driver? If so, please indicate. | |
| What is the year of the vehicle? | |
| What is the make of the vehicle? | |
| What is the vehicle idendification number? | |
| When did you purchase or lease the vehicle? | |
| Was the vehicle new at the time of lease/purchase? | |
| Is the vehicle leased? | |
| Have you installed an alarm system other than that supplied by the manufactuer? |
Rating Information
| About how many approximate kilometers is teh vehicle driven each year? | |
| Is the vehicle used to commute to ework or school each day? | |
| If yes, approximately how far one way (km)? | |
| Is the vehicle used for business? If yes, please describe. | |
| About how many kilometers is it driven for business each year? | |
| Is the vehicle used to carpool? If so, describe number of passengers and frequency. | |
| Are you compensated to transport others? |
Coverages
| Select the limit of liability you require: | |
| Select the Collision deductable you require: | |
| Select your Comprehensive Deductable: | |
| Additioanl Coverages or Comments: |
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