Terrace Insurance Company - Wightman & Smith Insurance

Questions:

How long have you had homeowners insurance?

When does your current insurance expire?

Do you reside in or rent this property?

Reside In
Rent

How many families live in the home?

One Two Three Four

Do you operate any business activities out of the home?

Yes
No

Is your home within 300 meters of a fire hydrant?

Yes
No

Is your home within 8 km's of a fire hall?

Yes
No

What is your primary source of heat?

Do you have any wood heating devices?

Yes
No

How long have you resided in this home?

Do you presently have a mortgage?

Yes
No

Is anyone living in your home who is:

• 45 years or older?
• 55 years or older?
• 55 years or older?

Do you have a monitored fire or burglary alarm?

Yes
No

Have you made any insurance claims in the last 5 years?

Yes
No

What is the replacement cost value you are currently insured for?

$

If you don't know, or you are purchasing this residence, please provide the following information:

• How many stories is your house?
  
• How many square feet is the main floor of your house?
  
• Is there a basement?
  Yes
  No
• What type of exterior does your house have?
  
• What type of roof does your house have?
  
• Is there a garage or car port?
  Yes
  No
• If yes, how many cars?
  
• How many bathrooms are there?
  

When was your house built?

If your house was built before 1985, please provide the date that the following were last updated:

• Roof:
  
• Electrical:
  
• Heat:
  
• Plumbing:
  

Comments or Special Requests: