Towed Trailer Application

Please complete this form in its entirety to bind coverage. The insured’s signature is required to bind a policy.
Please note: as a subbroker you have no binding authority. Coverage will be bound once the application is received and approved by one of our brokers.

    Additional Applicant Details

    Is there an additional applicant to be added to the policy? (please insure both names show on the ownership)

    Is the trailer located at a premises other than the insured’s home address?

    If yes:

    Risk Details

    Is the applicant the registered owner of the trailer?

    Is the Trailer registered in the name of a company, corporation, estate or held in trust?

    Has the applicant been refused insurance or been cancelled or lapsed by an insurer?

    Is the Trailer owned and/or occupied by three or more unrelated individuals?

    Is the Trailer used strictly for recreational purposes?

    Is the Trailer rented or leased to others?

    Does the Trailer have any heating that was not factory installed?

    Are there any extensions and/or modifications to the Trailer other than factory installed?

    Is the trailer garaged, parked, situated or stored outside of the Insured’s province of residence?

    When not in use, is the trailer situated on a premises not owned or rented by the insured?

    Is the Trailer rebuilt or refurbished unit?

    Is the trailer registered and plated in the insureds province of residence?

    Is there any existing or unrepaired damage on the trailer?

    Is there more than 1 lienholder?

    Is there a lienholder/Interested Party?

    Additional Information

    Has the applicant had any claims on their recreational trailer in the immediately preceding 5 years?

    Is the trailer used or occupied as a residence?

    Payment type

    Signature of Insured

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        APPLICANT DETAILS

        EVENT/PROMOTION DETAILS

        This is not an insurance policy.
        To bind a policy, a full quote is required and the risk must meet all underwriting guidelines.

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            APPLICANT DETAILS

            EVENT/PROMOTION DETAILS

            This is not an insurance policy.
            To bind a policy, a full quote is required and the risk must meet all underwriting guidelines.

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