Forms

Download the Forms You Need from Capital Insurance Brokers

Need a form? Capital Insurance Brokers has collected a variety of forms you may require. We have forms for requesting a quote, obtaining payment authorization, cancelling a policy, and more. If you have any questions about how to fill out the following forms, please contact Capital Insurance Brokers in Edmonton for more details.

Common Forms

Cancellation Form (pdf) – All named insureds on policy must sign.
Vehicle Inspection Report Form (pdf) – Required on all vehicles 12 years or older.

Quotes

Auto Insurance Quote (doc) – Info needed to complete a basic auto insurance quote.
Home Insurance Quote (doc) – Info needed to complete a basic home insurance quote.

Aviva

Aviva Monthly Payment Authorization Form (pdf)
Aviva 13D Glass Coverage Limitation Form (pdf)

Intact

Intact Monthly Payment Authorization Form (pdf)
Intact Credit Card Payment Authorization Form (pdf)
Intact Credit Consent Form (pdf)

Nordic

Nordic Monthly Payment Authorization Form (pdf)
Nordic Credit Card Payment Authorization Form (pdf)

Optimum West

Optimum West Monthly Payment Authorization Form (pdf)
Optimum West Credit Card Payment Authorization Form (pdf)

Peace Hills

Peace Hills Monthly Payment Authorization Form (pdf)
Peace Hills Credit Card Payment Authorization Form (pdf)

Wawanesa

Wawanesa Monthly Payment Authorization Form (pdf)
Wawanesa Credit Card Payment Authorization Form (pdf)