Automobile Quote Name: Address: City: Province: Postal Code: Phone number: Email: Age of principal driver: Marital status of principal driver: Married Single Number of years licensed for principal driver: Gender of additional drivers under 25 years of age: Male Female Do driver(s) under 25 years of age have driver training certification: YesNo Any driving convictions in past 3 years: YesNo If so (# of convictions): Do you use your vehicle for business: YesNo Do you use your vehicle to commute to and from work: YesNo Year, make, and model of vehicle: Liability limit requested: $2,000,000 $1,000,000 Coverage Preferred: All perils Collision Comprehensive Specified perils Deductible: $500 $250 $1,000 Additional vehicles to be quoted: YesNo How many years have you consistently had an auto policy in force or been listed on someone else’s policy as a listed driver: Number of at fault claims in the past 10 years: How many years since last at fault claim (if within 10 years): How many years since last claim? (if within 10 years): What is your occupation: How many kilometers do you commute to work 1 way: Was your prior policy canceled for non payment: YesNo Was your policy lapsed for any other reason by the insurance company: Which insurance company has your current property insurance: Security code: