Policy Checkup: Auto

A checkup is as important for your insurance as it is for your personal health! This form will allow Capital Insurance Brokers to ensure accuracy of your insurance policy, double-check for discounts, and if necessary rework your upcoming renewal.

At any time, you can save your work in progress and come back by clicking the "Save and Continue Later" button near the bottom of the page. Once the form is complete, please make sure to click the "Submit" button to finalize the form for our brokers to review.

1Contact Info

2Drivers & Vehicles

3Coverage & Discounts

Assigned Broker
Client name*
Policy number*
Email
Best primary contact number
Secondary contact number
Please verify current address
Street Address Address Line 2 City Province Postal Code

Combined discount and additional coverages
You're almost done! The questions in this section will allow us to fine tune your coverage and look for additional discounts that you may be eligible for.
If you currently have home or tenant insurance with another company, would you like to get a quote to check for combined policy discounts?
- Yes
- Not applicable - I already have home insurance with the brokerage
- No, I'm not interested
Would you like to increase your policy limit to 2 million?
- Yes - increase to 2 million.
- I would like more than 2 million.
- Not applicable - already at 2 million
- No, not interested
As the costs of bodily injury lawsuits continue to rise, our latest brokerage recommendation is that clients carry at least 2 million liability coverage for auto insurance. The cost increase is fairly low for most clients (about 5%-10%). A personal umbrella policy is also available for higher limits than 2 million.
Please note: this form is for the purposes reassessing upcoming renewals only. No changes will be made until a broker has reviewed and confirmed the potential changes with you. If you require a time-sensitive change to your insurance policy, please call our office immediately.

By clicking "I agree", I consent and authorize my broker, agent or insurer to collect, use and disclose to appropriate third parties personal information as permitted by law for the purposes necessary to quote risks, investigate and settle claims, and detect and prevent insurance fraud, such as credit information, driving record information, and claims history.
Consent:*
- I agree

Policy Checkup: Auto

Driver Details

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Combined discount and additional coverages

Policy Checkup: Auto

Driver Details

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Combined discount and additional coverages

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