Quotes - Leibel MacMillan Insurance

Home Insurance

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Name:
Address:
City:
Province:
Postal Code:	(X1Y 2Z3)
Phone Number:	(123-456-7890)
Email Address:	(xxx@yyyy.zzz)
Do you own your own home, own a condo unit or rent?	Homeowner Condo Owner Renter
Estimated replacement value of dwelling: (homeowner only)
Estimated replacement value of personal property: (condo & renters only)
Policy deductible preferred:
Liability amount requested:

How many years have you consistently had a property policy in force?*
Number of claims in the past 10 years?*
How many years since last claim (if within 10 years)?*
Do you smoke?*
Do you have a monitored alarm? (fire & burglary)*
Do you have a mortgage/secured line of credit on the property?*
What is your occupation?*
How many years since last time you moved?*
What is your age? (or oldest age of named insured person)*
Was your prior policy canceled for non payment?*
Was your policy lapsed for any other reason by the insurance company?*
What is the amount of jewelry required to be scheduled?*
Which insurance company has current your auto insurance?*