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Name
E-mail
Address
City
Province
Postal code
Phone Number
Do you own your home or condo unit or rent?
Home Owner
Condo Owner
Renter
Estimated replacement value of dwelling (homeowner only)
Estimated replacement value of personal property (condo & renters only)
Policy deductible preferred:
$200
$300
$500
$1,000
Liability amount requested:
$500,000
$1 million
$2 million
Have you had any personal property claimed in the past three years?
Yes
No
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