Easyway Insurance

Insurance for Tenants

GENERAL INFORMATION

Your Name:

E-Mail Address:

Telephone Number (between 9am-5pm): ( )

Address:

Postal Code:

When do you want coverage to begin (DD/MM/YYYY):

ABOUT YOUR TENANTS INSURANCE

What would you estimate the replacement cost of the personal property belonging to you and your family? (This includes all items such as furnishings, clothing, toys, appliances, etc. For a checklist to help you estimate please click here).

If other, please describe:

DISCOUNTS

Does your home have a monitored burglar alarm system? Yes No

What year was your home built?

Do you currently have home, condominium or tenants insurance? Yes No

If yes, for how long have you been a policyholder?

Have you had any claims under a home, condominium or tenants insurance policy within the past three years? Yes No

What is your birth date? (DD/MM/YYYY):

Disclaimer

You are applying for habitational insurance based on the information provided above as well as any information that may be available from reports ordered on your property. This information may include a history of insurance claims. You authorize Easyway Insurance Brokers Inc. to collect and disclose information as permitted by law and required by insurance companies for the purposes necessary to assess your application for new or renewal habitational insurance, investigate and settle claims and detect and prevent fraud. You also agree that Easyway Insurance Brokers Inc. may collect and use this personal information to consider your on-going needs for insurance products. You understand that your personal information may be disclosed pursuant to any relevant privacy laws or other laws.

I Agree Yes No