AXION-WALKER INSURANCE SERVICES

Name

Address

City

Province

Postal code

Phone number

Email address

Type of property insurance

Homeowner Condo owner Renter

Is there more than one owner

Yes No

Name of co-owner

What year was the property built

Estimated replacement value of dwelling (homeowner only)

How many years of continuous property insurance

Number of claims of any kind in the last 10 years

Number of mortgages on the property (homeowner/condo)

Any cancellations by any insurer in last 5 years

Yes No

Name of current insurer

Policy expiry date (DD/MM/YY)