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604-531-3599

reception@weeksinsurance.ca

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Stratford Insurance

Insured Name or Business Name *

Date insurance is required?*

Vehicle Make*

Vehicle Model*

Vehicle Year*

Postal code where vehicle is usually garaged?

How is the vehicle used?

Year the principal operator began driving?

Estimated number of principle operator at fault accidents?

Are there any drivers with less than 10 years driving?

Are there any drivers with an at fault accident in the past five years?

Number of comprehensive claims in the past five years?

Principal operators number of penalty points in the past five years?

Estimated annual kilometers?

Will any driver carry passengers for compensation?

Excess liability Coverage?

Collision deductible?

Comprehensive deductible?

Replacement Insurance?

Stratford Auto Package? (Similar to ICBC Roadside Plus)

Comments

Weeks Insurance & Financial Services Inc.

101-2982 152 St.

Surrey, BC V4P 3N7

Phone

Email

reception@weeksinsurance.ca

Hours

Monday –Friday:

9:00 AM - 6:00 PM

Saturday:

9:00 AM - 5:00 PM
Sunday: Closed

New Emergency After-Hours Claims

Copyright Weeks Insurance & Financial Services Inc.

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