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×
Personal
Home Insurance
Condo Insurance
Tenant Insurance
Cottage or Seasonal Property Insurance
Life & Health Insurance
Travel Insurance
Umbrella Liability Insurance
Personal (Continued)
Auto Insurance
Classic Car Insurance
Motorcycle Insurance
ATV & Snowmobile Insurance
Motorhome & Trailer Insurance
Watercraft Insurance
Commercial Insurance
Industry Specific Insurance Policies
Farm Insurance
Commercial Property Insurance
Commercial Liability Insurance
Professional Liability Insurance
Surety Bonding Insurance
Commercial Auto & Fleet Insurance
Cyber Liability & Privacy Breach Insurance
Drone Insurance
Legal Expense Coverage
Group Insurance
Cottage Associations
Bruce Power
About Us
Our Team
Contact Us
Daniel T. Craig Memorial Golf Tournament
Community Involvement
Testimonials
Resources
Self Serve
Make A Payment
Make a Claim
News
Refer A Friend
Contact Us
1-800-282-1915
Client Portal
Menu
Quote Form
Auto Insurance
1
Basic Information
2
Vehicle Information
3
Driver Information
4
Coverage Date & Submit
Basic Information
Full Name
Phone
Email Address
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Total number of vehicles in household
1
2
3
4+
Numbers of licensed drivers living in your household (including yourself):
1
2
3
4+
Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
VIN (optional)
Purchase or lease date of vehicle:
Month
1
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10
11
12
Day
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Year
2019
2018
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2012
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2010
2009
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1999
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1991
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1984
1983
1982
1981
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1945
1944
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1941
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Purchase Condition:
New
Used
Approximate number of kilometres driven annually:
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:
Yes
No
Name of the primary driver of this vehicle:
Winter tires (All Season tires do not quality as winter tires):
Yes
No
Add Additional Vehicle?
No
Yes
Additional Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
VIN (optional)
Purchase or lease date of vehicle:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
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28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Purchase Condition:
New
Used
Approximate number of kilometres driven annually:
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:
Yes
No
Name of the primary driver of this vehicle:
Winter tires (this discount is not available with "All Season" tires):
Yes
No
Add Additional Vehicle?
No
Yes
Additional Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
VIN (optional)
Purchase or lease date of vehicle:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Purchase Condition:
New
Used
Approximate number of kilometres driven annually:
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:
Yes
No
Name of the primary driver of this vehicle:
Winter tires (this discount is not available with "All Season" tires):
Yes
No
Driver Information
Driver Name
Date of birth
Driver's licenses number
Marital status:
Single
Married
Common Law
License Class
G
G2
G1
Date first licensed:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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11
12
13
14
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16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Completed Driver's Training Program:
No
Yes
Years continuously insured:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Years with current insurance company:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Number of traffic tickets (excluding parking tickets) in the past 3 years:
Select...
0
1
2
3
4+
Number of claims, NOT involving accidents, in the past 6 years
Select...
0
1
2
3
4+
Number of claims involving accidents in the past 6 years
Select...
0
1
2
3
4+
Number of times driver's license suspended in the past 6 years:
Select...
0
1
2 or more
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:
Select...
0
1
More
Reason for most recent cancellation:
Select...
Non-payment of premiums
Non-disclosure of information
Misrepresentation of information
Other
Add Additional Driver?
No
Yes
Additional Driver Informaton
Full Name
Date of birth
Driver's licenses number
Marital status
Single
Married
Common Law
License class:
G
G2
G1
Date first licensed:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Completed Driver's Training Program
No
Yes
Years continuously insured:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Years with current insurance company:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Number of traffic tickets (excluding parking tickets) in the past 3 years:
Select...
0
1
2
3
4+
Number of claims, NOT involving accidents, in the past 6 years
Select...
0
1
2
3
4+
Number of claims involving accidents, in the past 6 years
Select...
0
1
2
3
4+
Number of times driver's license suspended in the past 6 years:
Select...
0
1
2 or more
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:
Select...
0
1
More
Reason for most recent cancellation:
Select...
Non-payment of premiums
Non-disclosure of information
Misrepresentation of information
Other
Add Additional Driver?
No
Yes
Additional Driver Informaton
Full name
Date of birth
Driver's licenses number
Martial status
Single
Married
Common Law
License class:
G
G2
G1
Date first licensed:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Completed Driver's Training Program:
No
Yes
Years continuously insured:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Years with current insurance company:
Select...
Not currently insured
0-1
1
2
3
4
5
6
7
8
9
10+
Number of traffic tickets (excluding parking tickets) in the past 3 years:
Select...
0
1
2
3
4+
Number of claims, NOT involving accidents, in the past 6 years
Select...
0
1
2
3
4+
Number of claims involving accidents, in the past 6 years
Select...
0
1
2
3
4+
Number of times driver's license suspended in the past 6 years:
Select...
0
1
2 or more
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:
Select...
0
1
More
Reason for most recent cancellation:
Select...
Non-payment of premiums
Non-disclosure of information
Misrepresentation of information
Other
General Comments
Coverage Start Date:
If there is a specific CMR Broker you would prefer to deal with please enter their name here:
How did you hear about CMR Insurance?
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Family member or friend referred me
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