Business Insurance

Name:

Address:

City:

Province:

Postal Code:

Phone Number:

Email Address:

Have you ever had insurance cancelled or refused?

Yes

Do you currently insure your business?

Yes

When should coverage start? (dd/mm/yyyy)

Type of business:

Product/service provided:

Annual sales:

Number of employees (including yourself):

When was your property built?

Is it in a:

Sprinklered?

Yes

Wall construction:

Floor construction:

Roof construction:

If property is over 20 years old, have any of the following been replaced/updated?

Alarm system:

If yes, is alarm

Proximity to fire services:

Current Coverage Information

Building amount:

Stock amount:

Equipment amount:

Liability:

Deductible:

Business interruption:

Outdoor signs:

Business tools:

Exterior glass:

Yes

Recent claims:

Type:

Date (mm/yyyy)

#1:

#2:

#3:

Comments:

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