Tenant Insurance Form

    Address: Tippett Park - 20 Monte Kwinter Court, Toronto, ON M3H 0E1

    D.O.B. Co-applicant D.O.B. Relationship

    Expiry Date

    Has your property insurance been cancelled or refused (ie. non-payment or underwriting reasons) in the past 3 years?
    If yes, please indicate when and why

    Have you had any claims including water damage in the last 5 years?
    If yes, please indicate when and why

    Occupancy of Property Are all occupants non-smokers?

    For a multi-policy discount, do you also have auto insurance?
    If yes, insurer name

    Contents Limit Required

    Additional coverages required (jewelry, watercraft, home business extension)

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