Cottage Insurance Application Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance General InformationApplicant Name First Last MAILING address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code address to receive mail PhoneEmail Date of Birth Month Day Year Have You Ever Had Insurance Cancelled, Not-Renewed or Denied for any reason? Yes No Have You, Or The Location In Question, Ever Experienced Any Property Claims, Whether Covered By Insurance Or Not? Yes No Please describe the type of claim or damage that occurred. Could you also provide the date it happened, the payout of the claim, and whether it was processed through insurance? Additionally, please specify if the claim has been closed.Property DetailsAddress Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Address of the Property Seeking Insurance For.Year BuiltThe year the dwelling was constructed.What Best Describes The Property Primary Residence: Used primarily as the main living residence Seasonal/Vacation Home: Used occasionally during certain seasons or for vacations Weekend Retreat: Primarily used for weekend getaways Rental Property- Short Term: Rented out to others for short term stays Rental Property – Long Term: Rented out to otehrs for longer periods (e.g. 1 month to a year) Mixed Use – Personal and Rental: Used both as a personal retreat and rented out at different times. Other Other, Use: Please DescribeWhat Best Describes How the Property Is Owned By 1-2 Family Members By 3 or More Family Members Property in a Corporation By Investors Property is in a Trust Other Is There a Mortgage on The Property? No Yes – Just 1 with bank or credit union Yes – 2 with bank or credit union Yes – 1 mortgage or more with private lender or lender other than bank or credit union How Many Years Have you Had Continuous House Insurance for?How long have you had house insurance on this property for?What is the date the property was first purchased or if it a new purchase, what is the closing date?Property Ownership-Other, DescribeIs This Property on an Island? Yes No Does This Property Have Accessible Road Access All Year Round? Yes No Accessible meaning the roads are kept all year round.Is This Property on Water Yes No Such as beside a lake or river.Is There a Dock Yes – Permanent Dock Yes – Dock Which is Placed in for the Season No Is the Dock wood or plastic? Wood – Regular Wood – IPE or similiar hardwood Plastic Other How Many SQF is the Dock?Is The Property Hydrant Protected? Yes – Within 150M Yes – Within 300M No Does The Property Have a Firehall Within 7KM? Yes No Is the Property on a Septic System? Yes No Is the cottage on a septic system? Yes No Is there a pump for the septic system or is it gravity? Yes – there is a pump No – Gravity Fed What Best Describes the Firehall Fully Stationed 24/7 by Career Firefighters Volunteer Firefighters Name of FirehallIs There Any ICF Construction? Yes No If ICF – Is All Stryofoam Covered With Drywall? Yes No How Many Stories is the Home?What is the Square Footage Above Grade?How many square feet is the basementWhat %percentage is the basement finished?How Many Bathrooms are there?Is there any type of swimming pool or hot tub? Yes No Please Check if the Property Has any of the Following: Monitored Burlgar Alarm Local Burglar Alarm Heat Sensor Cameras Connected to Internet Is There a Backup Generator? Yes No Exterior Siding – Check All That Apply Vinyl Wood Stone Fiber Cement Metal Stucco Other Other – Exterior SidingPlease DescribeRoof Material Asphalt Shingle Metal Wood / Cedar Shake Tile / Slate Rubber Membrane Type of Electrical 200 AMP OR MORE WITH Breakers – COPPER WIRING 100 AMP WITH Breakers – COPPER WIRING LESS THAN 100 AMP WITH Breakers – COPPER WIRING 100 AMP OR LESS WITH FUSES – COPPER WIRING 100 AMP OR LESS WITH BREAKERS OR FUSES – ALUMINIUM WIRING OTHER OTHER ELECTRICAL – DESCRIBE:TYPE OF HEATING – Check All that Apply Furnace Air Handler Boiler In-Floor Hydronic Radiant No Heat Other OTHER HEATING – DESCRIBE:Type of Heat Source Propane Wood Natural Gas Oil Electric – Grid Electric – Grid/Solar Electric – Solar Other Other Heat SourcePlease DescribeType of Plumbing COPPER PEX OTHER OTHER PLUMBING – DESCRIBE:What Year Was the Roof UpdatedWhat Year Was the Electrical UpdatedWhat Year Was the Plumbing UpdatedAre There ANY Wood Burning Appliances YES NO such as wood burning inserts, wood burning furnaces, wood burning fireplaces or wood burning stoves..etcWood Burning:YES – Are the Appliance(s) WETT Certified WIthin The Last Year YES NO Are Wood Burning Appliances or Chimney Cleaned Annually By WETT Certified Technician YES NO How Many Cords a Year are Burned Annually with Wood Burning Appliances?cord: a pile 8 feet long, 4 feet high and 4 feet widePlease Describe Procedure to Remove of AshesDescribe Detached Structures – Check All That Apply There is a Boat House on Land There is a Wet Boat House (Boat House on Water) There is a detached 1-2 Car Garage There is a detached 1-2 Car Garage with Bunkie/Living Quarters There is 1-2 Sheds Under 200 SQF each There are other or more detached structures Other/More Detached Structures – Please Describe Each Structure and Their Estimated Rebuilding Value, As Well as the Year BuiltAre There Any Saunas in or on the Property No Yes Additional Risk QuestionsDoes the Property Go Vacant for More than 30 days? Yes No Does the Property Have Any Tractors, Watercraft,, Canoes, Kayaks..etc, Bicycles, Off-Road Vehicles for Use? Yes No What kind of vehicles or watercraft does the property have for use?Is The Property Currently Under any Fire or Flood Advisory within 50KM? Yes No Disqualified from quoting Additional InformationWe understand that secondary properties and cottages can be very unique. Please describe to us any unique features or exposures of the property which may be relevant.CoveragesBuilding Coverage $Detached Structure Coverage $Contents Coverage $Rental Income $Liability Coverage $2 Million $5 Million More Require Sewer Backup and Overland Water Coverage? Yes No UntitledConsent(Required) I agree to the Privacy Policy and acknowledge the Disclosure Statement.
