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Section 1

Reference #
73-1919


Primary Policy #: * 
   
Is this Personal Household Goods: * 
 
 
 
Is this Commercial Goods?: * 
 
 
 
Select Policy Document Language: * 
 
Name of insured: * 
   
Address: * 
   
City: * 
   
Province: * 
 
Country: * 
 
Postal Code: * 
   
Email: 
   
Phone Number: * 
   

Section 2

Policy Effective Date: * 
 
Excess Contents Limit over and above primary policy: * 
 

Section 3

Are there ANY active forest fires within 50kms of the storage facility: * 
               

Section 4

Facility Code: * 
   
Unit Number: * 
   
Name of person completing this form: * 
   
Mailing Address of person completing form: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Phone Number: * 
   
Email: * 
   
Verify Email: * 
   

Section 5

I /We hereby declare that the answers and declarations above, whether in my own hand or not, are true and that I /we warrant that no material fact has been withheld or misstated and agree that this proposal will form part of the policy and will form the basis of the contract with underwriters. I /we understand that the underwriters may declare any policy issued void in the event of any false statement, misrepresentation, omission or concealment whether made intentionally, innocently or accidentally. For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd's Underwriters' insurance business in Canada
I/we agree: * 
        
   

HELPFUL INFORMATION

Here are a few things to try to get your certificate successfully:
  1. Check the screen for any error messages. They will appear in red above the location of the error.
  2. Double check your information to make sure it has been entered correctly.
  3. You can always start over from scratch if you are having issues.
  4. You may want to try a different browser. Sometimes the settings of a certain browser may cause a problem and using a different browser will allow you to complete your submission.

 

CUSTOMER SERVICE

E-mail:  storageexcess@tripemco.com
Phone: 1-800-461-5083
Hours: Ontario 8:30am to 4:30pm EST Alberta 8:30am to 4:30pm MST

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