1. Instructions

    1. Instructions

  2. Basic Information

    1. Please provide your full name.

    2. Please provide your email address.

    3. Please provide the full address of the property concerned.

    4. Please provide your primary contact number.

  3. Ownership & Financial Specifications

    1. Is the property for sale?

    2. *Are you satisfied with the service you receive from your current home insurance carrier?

    3. Is the property owned by a trust?

    4. If you have a mortgage, please provide the name of the lender(s).

    5. Do you escrow your home insurance payments?

  4. House Specifications

    1. Do you have a pool?

    2. Do you have a trampoline, treehouse, zip line or climbing wall on your property?

    3. Do you have an automatic whole house water shutoff device?

    4. Do you have a permanently installed whole house generator?

    5. Do you have a fire alarm monitored by a central monitoring service?

    6. Do you have a burglar alarm monitored by a central monitoring service?

    7. Do you have a finished basement?

    8. Do you get water in your basement?

    9. Do you have a sump pump?

    10. Please indicate the year built, style, and estimated square footage of your home.

    11. Have you renovated or made any additions to your property in the past 5 years?

    12. How old is the oldest section of your roof & material?

  5. Heating & Plumbing Specifications

    1. What type of fuel heats your home?

    2. What is the age of your furnace or boiler?

    3. Do you have a wood or pellet stove?

    4. Do you have circuit breakers?

    5. If any, please describe the updates you made to your plumbing in the past ten years.

  6. Additional Questions

    1. Does anyone smoke that lives in the household?

    2. Do you have valuable articles such as jewelry, fine arts, guns, or silver that you would like estimates to add to the policy?

    3. Do you work out of your home?

    4. Do you own any watercraft or recreational vehicles?

    5. Please provide details of any pets you own.

    6. Do you own any additional property or land or rent any portion of your home to others?

    7. Do you have anything else to add?

Home Insurance Questionnaire


Home Insurance Questionnaire

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Please provide your full name.

Please provide the full address of the property concerned.

This includes the property number, street address, city, province and zip/postal code.

Please provide your primary contact number.

This should be a phone number we're able to contact you on if ever we need to discuss something with you.

Is the property for sale?

  • Yes

  • No

*Are you satisfied with the service you receive from your current home insurance carrier?

Please explain and provide details regarding your experience.

  • Satisfied

  • Neutral

  • Not Satisfied

Is the property owned by a trust?

  • Yes

  • No

If you have a mortgage, please provide the name of the lender(s).

Do you escrow your home insurance payments?

This refers to an arrangement in which the bank pays the home insurance.

  • Yes

  • No

Do you have a pool?

  • Yes

  • No

Do you have a trampoline, treehouse, zip line or climbing wall on your property?

  • Yes

  • No

Do you have an automatic whole house water shutoff device?

  • Yes

  • No

Do you have a permanently installed whole house generator?

  • Yes

  • No

Do you have a fire alarm monitored by a central monitoring service?

  • Yes

  • No

Do you have a burglar alarm monitored by a central monitoring service?

  • Yes

  • No

Do you have a finished basement?

  • Yes

  • No

Do you get water in your basement?

  • Yes

  • No

Do you have a sump pump?

  • Yes

  • No

Please indicate the year built, style, and estimated square footage of your home.

Have you renovated or made any additions to your property in the past 5 years?

  • Yes

  • No

How old is the oldest section of your roof & material?

Please indicate the type(s) of roof coverings such as asphalt, architectural asphalt, cedar shingles, slate and or rubber.

What type of fuel heats your home?

For example, oil, natural gas, propane gas, electricity, etc.

What is the age of your furnace or boiler?

Do you have a wood or pellet stove?

Please provide the age of the stove too.

Do you have circuit breakers?

If you know the amps, please indicate.

If any, please describe the updates you made to your plumbing in the past ten years.

Does anyone smoke that lives in the household?

Oh no. It looks like someone hasn’t provided any options for you to select from.

Do you have valuable articles such as jewelry, fine arts, guns, or silver that you would like estimates to add to the policy?

Please provide details of these items.

Do you work out of your home?

Do customers visit your home?

Do you own any watercraft or recreational vehicles?

  • Yes

  • No

Please provide details of any pets you own.

For dogs, please indicate the age, breed, and any history of aggressive behavior.



Do you own any additional property or land or rent any portion of your home to others?

  • Yes

  • No

Do you have anything else to add?