Kovacs Insurance

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Joseph Kovacs Insurance

HOME INSURANCE
QUOTE FORM

To receive a quote for home insurance please complete
the following form:
(You must be a resident of Ontario) 

Contact Information: 

Name:
Street Address:
City:
Postal Code:
Phone Number: 
Fax Number:
E-mail:

  
Insurance Information:

Have you had any claims in past 5 years?  Yes No 

(The following may be used to collect past claims information)

Name of last insurance company:
Policy Number:

Home Details:

Type of Dwelling:
Number of Stories:
Ground Floor Sq. Footage Sq. Ft.
Construction Type:
Other Type:
Roof Covering:
Other:
Primary Heat:
Other:
Does Dwelling include a garage? Yes No 
If yes, number of cars:
Garage Type: Detached Attached Carport 

 
Dwelling also includes:

Finished Basement Sq. Ft.
Unfinished Basement Sq. Ft.
Finished Attic Sq. Ft.
Deck Sq. Ft.
Swimming Pool Depth. ft.
Wood Stove Yes No 
Central Air Yes No 
Sunroom Sq. Ft.

Would you consider the dwelling to be:

Standard  Custom  or Luxury 


Year of Construction: 

If the dwelling is over 30 years old, in what year was the following most recently updated:

Electrical  Plumbing  Roofing  Heating 

Is the dwelling hydrant protected? Yes No 
If not, how far from nearest fire hall?  kilometers

How many smoke detectors? 

How many deadbolts? 

Do you have an alarm system?   Yes No 

Value of personal articles:

Jewelry $ Furs $
Fine Art $ Other $

Is there watercraft on your present  policy? Yes No 

Your present dwelling limit: $
Contents: $
Liability $
Deductible $

When should we contact you?:

How should we contact you?

  E-mail    Phone    Fax    Mail 

Thank you for filling out our online quote. Please allow a few days for a response. You can now hit the submit button below to send the information or the reset button to clear the form. 


 

JOSEPH KOVACS INSURANCE LIMITED
48 Front St. E., P.O. Box 7 Strathroy, Ontario N7G 3J1

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