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About the home to ensure:
Province:
City:
House type:
Year built:
Purchase date:
Number of mortgagee:
Number of units:
Surface of your home:
House construction type:
Do you own an outside swimming pool:
Heating:
Auxiliary Heating:
Number of smoke detectors:
System against fire:
System against theft:
About the insurance:
Insurance amount requested:
If insured, for how many years:
Expiration date of your policy:
About the occupants:
Occupation:
Employer:
Home small business:
Who will occupy the house in question:
Other information:
Are you the owner:
Insurance contract cancelled or refused (5 years):
Did you ever had any claims (5 years):
Did you ever had more than 3 claims (5 years):
Do you currently have an insurance policy:
Located within 8 km of a fire station:
Located within 300 m (1000 ft) of a fire hydrant:
Applicant Information:
Your name: *
Email:
Phone: *
Add other details to your request:
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