Welcome to Gifford Associates

Condo Advantage
for Unit Owners

Application Form
Named Insured
First Name:
Last Name:
Mailing Address
Address:
City:
Province:
Postal Code:
Country:
Location Address
Address:
City:
Province:
Postal Code:
Country:
Home Telephone:
Office Telephone:
Fax#:
E-mail:
Condominium Corporation number
Usage of premises:
Principal Residence
Rented to others
Central Alarm System:
Burglary
Fire
Business Operations on Premises?
Yes
No
If yes, please describe:
Age of Dwelling:
Heating Type:
Effective Date:
Limits of Insurance Required
Personal Property
Optional Coverage Available (At Additional Cost)
Earthquake Coverage
Yes
No
Bylaws Coverage
Yes
No
Jewellery if over $7,000:
Limit Required:
Description:
$2 million Liability Limit:
Additional Information
Previous Insurer:
Policy Number:
Insured Date of Birth:
Claims in last 5 years?
Yes
No
If yes, please describe:
Client Signature:

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Last modified Monday, June 27, 2011

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