RV INSURANCE APPLICATION FORM

Please fill out the RV 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.

    RV & MOTORHOME APPLICATION (Please complete ALL questions)

    Owner(s) Full Legal Name:

    Date of Birth:

    Address / Postal Code:

    Occupation:

    Email:

    Phone:

    General

    How did you hear about us:

    Previous Insurer:

    Expiry Date:

    Unit Information

    Make:

    Model:

    Length:

    Year

    Current Value:

    Value of a new Unit:

    Serial/VIN Number

    Type of RV

    Class

    Permanently Parked Location? YesNo

    If yes, address and postal code:

    Usage:

    Any previous claims or losses?

    If yes, provide details:

    Any unrepaired damage?

    If yes, provide details:

    Lienholder?

    If yes, provide details:

    Lifts?YesNo

    Skirted?

    Area of operation:

    Additional Information: (Does the Unit have any of the following Information)

    Extra

    Contents Amount: