Auto Insurance Quote Auto Form Coverage Effective Date Vehicle Details Vehicle Make Year 19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Vehicle Brand Vehicle Model Vehicle condition at the time of purchase NewUsedDemo Owned or Leased? OwnedOwned(financed)Leased Date of purchase What is the approximate average annual driving distance (km) for this vehicle? 1000 KM2500 KM5000 KM10,000 KM15,000 KM20,000 KM50,000 KMOther Enter Annual Driving Distance (in KMs) Select the choices that apply to your annual driving distance, if applicable: Commute to work or schoolUsed car for business purpose Please advise your one -way commuting distance Please provide the annual kms used for business Parked at Night? Parking lot Private Driveway Private Garage Street Underground Parking Secure Condo/Apt Garage Unsecured Condo/Apt Garage or Lot Do you put four winter tires on this vehicle from December 1 to March 31 every year? Yes No Do you want to sign up for safe driving program (Telematics – Smartphone app)? Yes No Coverage required? Full Third Party Add New Vehicle Remove Vehicle If you are human, leave this field blank. Next
