Renter Insurance Form - CMR Insurance

Applicant Information & Insurance History PLEASE NOTE after completing this form a Broker will contact you to provide your quote
Full name
Date of birth
MM slash DD slash YYYY
Phone
Email address
Gender
Marital Status
If there is a co-applicant, please provide their full name
Date of birth of co-applicant
MM slash DD slash YYYY
Are all members of the household non-smokers
- Yes
- No
How many years have you had property insurance
How long have you been insured with your current company
How many property insurance claims have you had in the past 5 years?
Have you ever had home insurance cancelled or refused in the past 5 years
Reason for most recent cancellation/refusal

Property Information
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Do you currently occupy the dwelling
- Yes
- No
Estimated square footage of your unit
Enter the amount of contents insurance you require (The amount you would need to replace all of your personal property (furniture, clothes, clothing, etc))

Do any of the following apply to your property? Please select from the list below:
- Monitored Fire Alarm
- Monitored Burglar Alarm
- 24 Hour Conceirge/Security
- 24 Hour Video Surveillance System
- Jewellery valued at over $6000
- Personal use drone
- Cannabis grown on premises
- Home based business
- Personal use drone
General Comments Box
Coverage Start Date
MM slash DD slash YYYY
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
If someone referred you to CMR, please provide their full name in the text box to the right so that we can send them a proper thank you

Applicant Information & Insurance History PLEASE NOTE after completing this form a Broker will contact you to provide your quote