auto insurance form 0.00 Location Post Code All Vehicles Vehicle Information Vehicle Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 vehicle make AcuraAlfa RomeoAudiBMWBuickCadillacChevroletChryslerDodgeFiatFordGenesisGMCHondaHyundaiInfinitiJaguarJeepKiaLand RoverLexusLincolnMazdaMercedes-BenzMiniMitsubishiNissanPolestarPorscheRamSubaruToyotaVolkswagenVolvo vehicle model financed / leased / Own FinancedLeasedOwn purchase date what is the primary use of this vehicle? PersonalBusiness how many kilometres are driven to work or schoold one way each day? 0 KM5 KM10 KM20 KM30 KM40 KM50 KM60 KM70 KM80 KM90 KM100 KM110 KM120 KM how many totall kilometres are driven each year? 500 KM1000 KM2000 KM3000 KM4000 KM5000 KM6000 KM7000 KM8000 KM9000 KM10000 KM20000 KM30000 KM50000 KM60000 KM80000 KM100000 KM comprehensive coverage? YesNo collision coverage? YesNo Third party libility 1,000,0002,000,000 × Add new All Drivers Driver Information First Name Last Name Marital Status SingleMarriedCommon Law Date of Birth Gender MaleFemaleX Occupation Status EmployedUnemployedStudentRetired Licence Information G1 Licence Date G2 Licence Date G Licence Date 0.00 From G licence date to G1 licence date is over five years. When was Driver first listed as a driver on an insurance policy in Canada or US? Input the year How long has Driver been with current insurance company? Input the year In the past 3 years, have you ever had: Any insurance company cancel your policy? YesNo Reasons for cancelled Reason Cancelled for non-paymentCancelled for other reasonCancelled for materials misrepresentationCancelled for materials misrepresentation Please select the start date of the insurance cancellation Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Month 123456789101112 End DatePlease leave the reinstatement date questions blank if you do not have an active policy. Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Month 123456789101112 × Add new Any time without insurance coverage? YesNo Time without insurance Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Month 123456789101112 × Add new Have you had any suspensions in the past 6 years? NoneOneTwoMore If any suspensions Indicate the year Have you had any at-fault accidents? YesNo If any accidents indicate how many time and date & year Have you had any tickets (not including parking) in the past 3 years? YesNo List of tickets Ticket list Speeding ? 49 km/h over the limit or lessBacking up ? Unsafe/illegal/improperBrakes ? None/inadequate/improperCrowding driver?s seatDisobeying flagmanDoor opening ? Illegal/obstructing trafficDriving off roadway (including shoulder/sidewalk/median)Headlights/parking lights ? Improper/lack of useHaving open alcohol in the carFail or refuse to surrender licenseFail to produce evidence of insuranceFail to carry insurance cardFail to have insurance cardFail to disclose particularsFail to notify policeGail to make written reportEmergency vehicle ? Operating with no regard for safetyDriving imprudentlyDriving off roadwayFlagman ? DisobeyingFollowing too closelyHeadlights/Parking light ? Improper/Lack of useLack of control of vehicleMotor-assisted bicycle ? Carrying passengersMotorcycle ? Operating with only an instruction permitMotorcycle ? Failure to wear helmetPassing infraction (Except school bus/school zone)Pedestrian crossing violationRadar warning device in motor vehicleRailway crossingSafety zone violationSeatbeltFail to signalSlow drivingSmokescreen device on vehicleSquealing tiresStopping ? Illegal/improperDefective/Worn tiresProhibited/unsafe towingDisobey traffic signTires ? Defective?wornTrailer ? Improper attachments/Improper towingProhibited turnDrive with improper license classUnsafe moveUnsafe towingUnsafe vehicleUsing a hand-held wireless communication device (Update: some insurance companies consider this to be major ticket now).Drive on wrong side of roadFail to yieldFailing to report an accidentFailing to give name and license number after an accidentImproper passing of a school busSpeeding in a school zoneProduce false evidenceFalse Statement regarding insuranceProduce false insuranceMake false statementPermit unlicensed driver in contravention of conditionsViolation of any class G1, G2, M1, or M2 conditions (Other than alcohol-related)Failure to stop for police officerFailure to stop for emergency vehiclesFail to report damage to highway propertyCriminal negligence with a motor vehicleVehicular manslaughterDriving while license is suspendedRacingStuntingCareless drivingDriving without due care and attentionDriving without insuranceOperate motor vehicle ? No insuranceVehicle owner without insuranceNo insuranceDangerous drivingImpaired drivingFailure to submit to a breath or blood testOver .08 blood-alcohol levelDriving without an interlock device where it is requiredSpeeding ? 50 km/h or more over the limitFailure to remain at the scene of an accidentClass G1, G2, M1, M2 ? Fail to provide breath sampleClass G1, G2, M1, M2 ? Drive with alcohol in blood Please indicate the date for ticket Month 123456789101112 Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 × Add new × Add new Discount Information Winter tire discount YesNo Install an app on your phone YesNo Combine discount with property？ YesNo 0.00 Home Information Type of insurance OwnedTenantRented Propery Type DwellingCondo Rented to how many families? 0123More Home Address Home size without basement Under 499 Sqft500-999 Sqft1000-1500 Sqft1500-2000 Sqft2000-3000 Sqft3000-4000 Sqft4000-5000 SqftMore than 5000 Sqft finished or partially finished basement? YesNo How many garages or carport? 0123More If home has a swimming pool, what type is it? NoneIn-groundAbove ground Any update for home if home age more than 15 years? Roof update 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Indicate the year Water heater update 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Indicate the year The home has a deck? YesNo Deck size 1-250 Sqft251-500 SqftMore than 500 Sqft Purchase yearIndicate the year Mortgagee NoneOneTwoMore Any central alarm？ YesNo Condo size Under 499 Sqft500-999 Sqft1000-1500 Sqft1500-2000 Sqft2000-3000 Sqft3000-4000 Sqft4000-5000 SqftMore than 5000 Sqft Condo Year 20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976 Indicate the year Home Owner Information Last Name First Name Date of birth Gender MaleFemaleX When would you like your policy to start? Any claim in past 5 years NoneOneTwoMore First got home insurance since Do you smoker? YesNo × Add new × Add new Free membership to CANADIAN GLOBAL ALUMNI ASSOCIATION *I would like to enrol free membership of Canadian Global Alumni. when would you like your policy to start? please provide your email address so we can send you a copy of your quotes Phone Number Email To get my quote, I consent to InsuranceHotline.com and Insurance Hotline Services disclosing my contact details for post-quote follow up, and agree to receive my quote information by email, SMS or phone call, and to keep me informed about offers and newsletters from InsuranceHotline.com as further described in the Privacy Policy. I may unsubscribe at any time. Are you agree the term? Quote