Pemberton Holmes RentalAssure Basic Information: Name of Homeowner(s): eg: John Smith Postal Address: eg: 830 Pandora Ave Victoria, BC, V8W 1P4 Email Address: eg: firstname.lastname@example.org Primary Phone: eg: 2501231234 Name of Property Manager: eg: Oliver Smith Email Address: eg: email@example.com Policy Effective Date: eg: 2018-01-30 Policy Expiry Date: eg: 2020-01-30 Previous insurance on this property? yesno Previous insurance on this property declined or cancelled by insurer? yesno Any claims in last 5 years? yesno Please provide details: Location Details: Location Address: eg: 830 Pandora Ave Victoria, BC, V8W 1P4 Monthly Rental Income: Value of additional buildings on property: Year Built: Number of Suites: Roof covering: ShakeTorch OnAsphalt ShingleT&GOther Total Building sqft: # of Stories: Basement? # of Bathrooms: # of Kitchens: Heating Type: Electrical Type: Plumbing Type: Updates: Heating: Roof: Plumbing: Wiring: Oil tank age: Within 300m of Fire Hydrant? Within 8km to a responding fire hall?