Home Insurance Questionnaire Form

Please complete the form below, then click the "Submit" button.

Full Name:
Date of Birth:
Occupation:
Email address:
Phone number:
Address of the home:
Postal code:
If mailing address is different please advise what it is:
Are you more than 13 kilometres away from a firehall?:
Are you more than 150 metres away from a fire hyrant?:
Is there a mortgage on the property?:
Are there any smokers in the home?:
What is the architecture style of the home?:
What is the square footage of the home not including the basement?:
What year was the home built?:
What is the primary siding?:
How many bathrooms are there?:
Is there an attached garage?:
If so, how big is the garage (how many cars)?:
Is there a deck?:
If so, what size is the deck (sq. ft.)?:
Is there a basement?:
If so, what is the square footage?:
Is the basement finished?:
Is it a walkout?:
Do you have a hot tub or a pool?:
Is there a home-based business operating from the home?:
Is there a fireplace or a wood stove?:
Is there any secondary heating?:

Please comment if any of the following have been updated and what year it was done.
Electrical
What type of electrical wiring is it?:
What type of amp is the electrical?:
Is it on a breaker circuit?:
Has the electrical source been updated and what year was it done?:

Heating Source
What type of heat is it?:
Has the heating source been updated and what year was it done?:

Roof
What is the age of the roof?:
Type of roofing material:

Plumbing
What type of plumbing material was used?:
How old is your hot water tank?:
Has the plumbing been updated and what year was it done?:
Hot water tank - is it a storage tank or tankless?:
Do you have a sump pump?:

Misc.
Do you have a security system?:
How long have you had property insurance?:
Any gaps in insurance coverage for more than 2 years?:
Have you had any claims in the last 7 years on your home?:
Do you have a boat or travel trailer?:
Do you require coverage for things such as jewelry, bicycles, golf clubs, etc.?:
What date would you like your policy to start?:

Please indicate which Wyatt Dowling branch you prefer to work with::

Credit Consent
In order to provide you with the most accurate quote with the maximum savings, the insurance companies will run a soft credit check with your consent. Even if you do not provide consent, we will still provide you a quote.
Do we have your consent to access and use your credit history information as described?:
By selecting this checkbox, I/we agree to all the terms and conditions required for the purpose of requesting a quote.
Thank-You for taking the time to complete this home insurance questionnaire. Wyatt Dowling is proud to provide various coverage options with multiple insurance carriers. We always strive to find the perfect coverage for your needs, allowing you to “Leave your worries at our door”.

Home Insurance Questionnaire Form

Electrical

Heating Source

Roof

Plumbing

Misc.

Credit Consent

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