Staebler Insurance Brokers

The Best Insurance Is An Insurance Broker

Home Insurance

Name:

Email Address:

Address:

City:

Province:

Postal Code:

Phone Number:

Do you own your own home, own a condo unit, own a farm or rent?

Homeowner
Condo Owner
Farm Owner
Renter

Estimated replacement value of dwelling: (homeowner only)

Estimated replacement value of personal property:
(condo & renters only)

Policy deductible preferred:

Liability amount requested:

Have you had any personal property claimed in the past three years?

Yes

Disclaimer:

H.L. Staebler Company Limited is not responsible for instructions not received and acknowledged by a confirmation via e-mail or phone call. By submitting this form, you acknowledge that you are the policyholder and the events described on this form are truthful. Only the person named as the insured in the policy documents can submit a claim report on this policy. All policy terms and conditions apply, subject to policy status at time of submission.