HOME INSURANCE APPLICATION FORM

Name: HG Insurance Agencies
Address: 100-630-17th Street, Castlegar, BC, V1N 4G7
Telephone: 250-365-3368
Price range: $
Rating: 4

Please fill out the home insurance application below to the best of your ability. If you have any issues, please don’t hesitate to call us at 1-250-365-3368. We will follow up after we successfully receive your submission.

Preferred Location (required)

Castlegar OfficeSlocan Park Office

Condition Removal Date YYYY-MM-DD (if new purchase)

Effective Date Insurance is Required YYYY-MM-DD (required)

How did you hear about us?

Owner Information

First Name (required)

Last Name (required)

Phone (required)

Your Email (required)

Birthdate YYYY-MM-DD (required)

On Title (required)
YesNo

Secondary Applicant Information

First Name

Last Name

Birthdate YYYY-MM-DD

On Title
YesNo

Current Insurance Company (Home/Tenants/Condo)

Current Insurance Policy #

Current Insurance Policy Expiry Date YYYY-MM-DD

Mortgagee Institution

Mortgagee Address

Previous Address in Past 3 Years

Have you had any claims in the past 5 years (list details)

Have you ever been cancelled, refused, or denied insurance?

YesNo

Years Continuously insured (no gaps)

Years Claims Free

If a new primary residence, will you occupy within 30 days?

YesNo

How long have your owned or occupied this property?

Occupancy of this location (required)

Is there an alarm system? (required)

Fire Hydrant within 300 meters? (required)
YesNo

Fire Hall within 8 km? (required)
YesNo

Detached Outbuildings(include type, size, value, siding, roofing, year built, quality):

1. 2. 3.

Will there be any roommates or boarders? (required)
YesNo

Will there be any business on premises? (required)
YesNo

Are there any suites in the home? (required)
YesNo

Will there be any home sharing rentals? (required)
YesNo

Will there be any marijuana grown on premises? (required)
YesNo

Would you like to include Earthquake? (required)
YesNo

Would you like to say yes to credit score discount? (required)
YesNo

Would you like to pay in full or monthly? (required)
FullMonthly

Any extensions of liability/scheduled items to add (bikes/jewellery/business property) (required)

YesNo

Dwelling Information

Address (required)

Year Built (required)

Main Floor Living Area (required)

Architecture Style (required)

Construction Type (required)

Construction Quality (required)

Physical Shape (required)

Primary Exterior Siding (required)

Primary Roof (required)

Bathrooms

Full (required)

Half

Description of Locale (required)

Has the home been completely gutted in the last 40 years?

YesNo

Historic Registry

YesNo

Garage

Square Footage

Year Built

Carport

Square Footage

Year Built

Porch

Square Footage

Year Built

Deck

Square Footage

Year Built

Additional Areas

½ storeyAtticBasement, finished, below gradeBasement, finished, walk outBasement, unfinished, below gradeBasement, unfinished, walk outBonus roomBreezewayCrawl spaceGreenhousePatio, coveredPatio, elevatedPergolaSolariumOther

½ storey Square Footage

Attic Square Footage

Basement, finished, below grade Square Footage

Basement, finished, walk out Square Footage

Basement, unfinished, below grade Square Footage

Basement, unfinished, walk out Square Footage

Bonus Room Square Footage

Breezeway Square Footage

Crawl Space Square Footage

Greenhouse Square Footage

Patio, Covered Square Footage

Patio, Elevated Square Footage

Pergola Square Footage

Solarium Square Footage

Other Space Square Footage

Other

Hot TubSwimming Pool, ingroundSwimming Pool, above ground

Hot Tub SizeHot Tub YearHot Tub Quality

Inground Pool YearInground Pool Construction QualityInground Pool Lining TypeInground Pool Size

Above Ground Pool YearAbove Ground Pool Construction QualityAbove Ground Pool Lining TypeAbove Ground Pool Size

Electrical Upgrades

Year
Copper/ Knob and Tube
Amp Service

Plumbing Upgrades

Year
Plumbing Material
Does your house have Poly-B plumbing?
YesNo

Any Galvanized/ Cast Iron

Roofing Upgrades

Year
Roofing Material

Heating Upgrades

Year
Primary Heat Source
Aux. Heat Source

Hot Water Tank Upgrades

Year
Gas/ Electric
Tankless/ Standard

Municipal Sewer/ Septic

Sewer Back Up Valve

If using wood heat, how many chords are burned /year

If using wood heat, is your unit CSA approved and WETT inspected (copy of WETT required)

*CURRENT COLOURED PHOTOS OF FRONT, BACK OF HOME AND OUTBUILDINGS REQUIRED FOR QUOTING
*WETT INSPECTION & COMPLETED WOODHEAT QUESTIONNAIRE FOR ALL WOOD BURNING UNITS REQUIRED
*ALL SUITES OR RENTING OF SUITES MUST BE DECLARED PRIOR TO INSURANCE BEING BOUND

HOME INSURANCE APPLICATION FORM

Preferred Location (required)

Condition Removal Date YYYY-MM-DD (if new purchase)

Effective Date Insurance is Required YYYY-MM-DD (required)

How did you hear about us?

Owner Information

Secondary Applicant Information

Current Insurance Company (Home/Tenants/Condo)

Current Insurance Policy #

Current Insurance Policy Expiry Date YYYY-MM-DD

Mortgagee Institution

Mortgagee Address

Previous Address in Past 3 Years

Have you had any claims in the past 5 years (list details)

Have you ever been cancelled, refused, or denied insurance?

Years Continuously insured (no gaps)

Years Claims Free

If a new primary residence, will you occupy within 30 days?

How long have your owned or occupied this property?

Occupancy of this location (required)

Is there an alarm system? (required)

Fire Hydrant within 300 meters? (required) YesNo

Fire Hall within 8 km? (required) YesNo

Detached Outbuildings(include type, size, value, siding, roofing, year built, quality):

Will there be any roommates or boarders? (required) YesNo

Will there be any business on premises? (required) YesNo

Are there any suites in the home? (required) YesNo

Will there be any home sharing rentals? (required) YesNo

Will there be any marijuana grown on premises? (required) YesNo

Would you like to include Earthquake? (required) YesNo

Would you like to say yes to credit score discount? (required) YesNo

Would you like to pay in full or monthly? (required) FullMonthly

Any extensions of liability/scheduled items to add (bikes/jewellery/business property) (required)

Dwelling Information

Architecture Style (required)

Construction Type (required)

Construction Quality (required)

Physical Shape (required)

Primary Exterior Siding (required)

Primary Roof (required)

Bathrooms

Description of Locale (required)

Has the home been completely gutted in the last 40 years?

Historic Registry

Garage

Carport

Porch

Deck

Additional Areas

Other

Electrical Upgrades

Plumbing Upgrades

Roofing Upgrades

Heating Upgrades

Hot Water Tank Upgrades

Municipal Sewer/ Septic

Sewer Back Up Valve

If using wood heat, how many chords are burned /year

If using wood heat, is your unit CSA approved and WETT inspected (copy of WETT required)

Castlegar Branch

250-365-3368

Slocan Valley Branch

250-226-7216

Greenwood Branch

250-443-9156

Quick Links

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Fire Hydrant within 300 meters? (required)
YesNo

Fire Hall within 8 km? (required)
YesNo

Will there be any roommates or boarders? (required)
YesNo

Will there be any business on premises? (required)
YesNo

Are there any suites in the home? (required)
YesNo

Will there be any home sharing rentals? (required)
YesNo

Will there be any marijuana grown on premises? (required)
YesNo

Would you like to include Earthquake? (required)
YesNo

Would you like to say yes to credit score discount? (required)
YesNo

Would you like to pay in full or monthly? (required)
FullMonthly