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    Vehicle One

    Is this vehicle used for business?

    Does this vehicle have 4 winter tires which are installed during the winter months?

    Vehicle Two

    Is this vehicle used for business?

    Does this vehicle have 4 winter tires which are installed during the winter months?

    Vehicle Three

    Is this vehicle used for business?

    Does this vehicle have 4 winter tires which are installed during the winter months?

    Effective Date

    Driver One

    Gender

    Date of Birth
    //

    When you received your G1 licence
    /

    When did you receive your G2 licence?
    /

    When did you receive your G licence?
    /

    Date you completed MTO approved Driver Training
    /

    Driver Two

    Gender

    Date of Birth
    //

    When you received your G1 licence
    /

    When did you receive your G2 licence?
    /

    When did you receive your G licence?
    /

    Date you completed MTO approved Driver Training
    /

    Driver Three

    Gender

    Date of Birth
    //

    When you received your G1 licence
    /

    When did you receive your G2 licence?
    /

    When did you receive your G licence?
    /

    Date you completed MTO approved Driver Training
    /

    Driver Four

    Gender

    Date of Birth
    //

    When you received your G1 licence
    /

    When did you receive your G2 licence?
    /

    When did you receive your G licence?
    /

    Date you completed MTO approved Driver Training
    /

    In the last 3 years, has any driver had any tickets (convictions) other than parking tickets?

    In the last 10 years, has any driver had any accidents?

    In the last 10 years, has any driver had their licence suspended or revoked?

    Insurance History

    Have all drivers been listed as drivers on an insurance policy?

    In the last 10 years, have you had any non-accident insurance claims (like theft or windshield claims)

    In the last 6 years, has your insurance policy ever been cancelled by an insurance company?

    Have you ever been convicted of insurance fraud?

    Saving Opportunities

    Do you currently have home insurance?

    Save up to 12% on your car insurance by insuring your home with us. Would you like to add this multi-line discount to your quote?

    May we have your consent to use your information for future marketing initiatives and to serve you better?

    Your Contact Information

    Please note; Your personal information will be collected and used to provide you with a car insurance quote and of creating a profile in your name.

    By providing their personal information, you agree that you have obtained their consent for the collection of this information in order to provide you with a car insurance quote.

     

     

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