Mobile Home Insurance: Property & Fire Protection

Download the printable PDF below:

For a straightforward way of obtaining a quote for your mobile home insurance needs, simply fill out the three paged form below and email it to kelowna@wvins.ca

Mobile home PDF

    MOBILE HOME APPLICATION

    Client Details

    Client 1.

    Full Legal Name:

    Date of Birth:

    Phone:

    Email

    Client 2.

    Full Legal Name:

    Date of Birth:

    Phone:

    Email

    Client 3.

    Full Legal Name:

    Date of Birth:

    Phone:

    Email

    Client 4.

    Full Legal Name:

    Date of Birth:

    Phone:

    Email

    Location Address:

    Mailing Address (if different):

    Name of Mobile Home Park (if applicable):

    Additional Named Insured (ANI):

    Union Member

    If Applicable, provide details:

    Previous Address ( If resided at current residence for less than 3 years )

    Previous Address:

    How many years have you resided at this address at:

    How did you hear about us?

    Previous Insurance History

    Insurer Name:

    Policy #:

    Effective Date:

    Expiry Date:

    Any claims in the last 5 years? YesNo

    If yes, provide detail:

    Any claims that you are aware of at the new location? YesNo

    If yes, provide detail:

    Have you ever been cancelled, refused, or declined insurance? YesNo

    If yes, provide detail:

    *If Applicable

    Effective Date:

    Subject Closing Date:

    Insured Since:

    Property Insured Since:

    Possession Date:

    Move in Date:

    Insured with Broker Since:

    Occupied Since:

    Mortgage / Credit Consent

    Mortgage: YesNo

    Credit Consent:YesNo

    Consent:VerbalWritten

    Number of mortgages / secured lines of credit:

    Name of financial institution:

    Mobile Home / Manufactured Details

    Year Built:

    Manufacturer:

    Model:

    Serial Number:

    Single Wide:YesNo

    Double Wide:YesNo

    Width:

    Height:

    Purchase Price:

    Content Value:

    # of smoke detectors:

    Garage:

    # of cars:

    Any decks or porches:YesNo

    If yes, Size:

    Any additions:YesNo

    If yes, Size:

    Is it fully skirted:YesNo

    Roof:

    Any Custom Features:

    Fire Protection

    Within 300m of a fire hydrant:YesNo

    Within 8km of responding fire hall:YesNo

    Heating

    Primary Heat Type:

    If Central Furnace, type:

    If woodstove or wood insert, # of cords burned annually:

    Year primary heat was updated:

    Auxiliary Heat Type (if applicable):

    # of cords burned annually (if applicable):

    How often is chimney cleaned:

    Professionally Installed: YesNo

    WETT Certified: YesNo

    Year auxiliary heat was updated:

    Oil Tank (if applicable)

    Location:

    Tank information:

    Year manufactured:

    Electrical


    If other, provide details:

    BreakersFuses

    Amps:

    Other:

    Year of any updates to electrical:

    Plumbing

    Type:

    Describe Other if selected

    Hot Water:

    Hot water tank age:

    Does the home have a boiler? YesNo

    Year of any plumbing updates:

    Sewer: SepticCity sewer

    Water Prevention Sump pump and/or Back flow valve

    Sump pump: YesNo

    Aux. power: PedestalSubmersibleFloor suckerWater powered

    Back flow valve: YesNo

    If yes: GateFlapper

    Additional Questions

    Is the dwelling under construction / renovations? YesNo

    If yes, provide additional information:

    Vacant: YesNo

    If yes, provide additional details

    How long has it been vacant?

    How long do you expect it to be vacant?

    Number of families living in the home:

    Any: Rental suitesRoommatesBordersStudents

    If yes, provide additional information:

    Rental Income $:

    Landlord contents $:

    Home Base Business:

    YesNo

    Name of business:

    Type of business:

    Clients visit home: YesNo

    Do you have a current CGL: YesNo

    Website:

    Any farming on premises YesNo

    Other

    Pool:YesNo

    If yes: In groundAbove ground


    Hot tub:YesNo

    Trampoline: YesNo

    Dock and/or Wharf: YesNo

    Earthquake coverage required:YesNo

    Number of cannabis plants grown on premises:

    Monitored burglary alarm: YesNo

    Interior sprinkler system in your unit: YesNo

    Please do not hesitate to reach out if you have any questions at all.

    The right products, great service, the best people

    Contact Us

    Phone: 1–800–663–4200 or (250) 860-6700
    Fax: (250) 861–6060
    Email: kelowna@wvins.ca

    Hours:
    Monday to Friday: 8:30am – 5:00pm
    Closed Weekends and all Statutory Holidays.

    156-1876 Cooper Road
    Kelowna BC
    V1Y 9N6