Tenants/Condominium Package Quote

Personal Information

Name

Contact person (if different)

Address - Street & City (Must reside in Manitoba, Canada)

Postal Code

Home phone

Business phone

Fax Number

E-mail (We can not respond unless you provide your E-mail address)

Date of birth: Day Month Year

Tenants/Condominiums Information

Amount of coverage desired (minimum $10,000)
$

Year apartment/condominium or dwelling was built:

Type of heat

Number of stories

Number of suites

Type of construction (ie. fire resistive, frame, brick)

Do you currently carry insurance? Yes No

Riders can be added to specifically insure certain types of property. Please indicate amounts of coverage required on riders.

Claims History

Please advise if you have had any claims or uninsured losses in the last 5 years:

Date of Claim	Type of Claim	Amount Paid

If outside of Winnipeg advise:

Is there a fire hydrant within 1000 feet? Yes No

Distance to the nearest responding fire hall