RV & MOTORHOME APPLICATION (Please complete ALL questions)

Owner(s) Full Legal Name:
Date of Birth:
Address / Postal Code:
Occupation:
Email:
Phone:

General

How did you hear about us:
Previous Insurer:
Expiry Date:

Unit Information

Make:
Model:
Length:
Year
Current Value:
Value of a new Unit:
VIN Number
Type of RV—Please choose an option—Travel TrailerFifth WheelTent TrailerCamper UnitPark Model

*We do not write class B

Usage: —Please choose an option—VacationFull-time TravelSnowbird (over 3 months)Full-time ResidenceFull-time WorksiteRented to others
Any previous claims or losses? YesNo
If yes, provide details:
Any unrepaired damage? YesNo
If yes, provide details:
Loan? YesNo
If yes, provide details:
Skirted?YesNo
Area of operation:CanadaUS and Canada

Additional Information: (Does the Unit have any of the following Information)

Secured parking - An RV Stored indoors, including garages and warehouses with locked gates/ and or doorswhile at home, in storage or not in use. OR permanently parked in a secure supervised RV parkRV Alarm – An alarm attached to and forming a part of the recreational vehicle that emits an audible alarmGPS Tracking – A GPS device attached to and forming a part of the recreational vehicle that sends a signal advising where the unit is located in real time.

Extra

Awning RC Extension Approx. $25CPL 2M Approx. $125 (Good to have for permanent residence)Increased Contents Approx. $15/$1,000Contents

Please note: Coverage is not considered bound until you have received confirmation from a licensed broker.

Your Privacy and Email Consent

We are committed to protecting your personal information and take all reasonable steps to keep it secure. However, email is not always a fully secure method of communication. There is a risk that messages may be intercepted, viewed, or stored outside of Canada depending on your email provider. We recommend deleting insurance-related emails after reviewing them to help reduce that risk.

I understand and accept the risks of communicating by email.* Yes