Auto Insurance Quote

Applicant Information

Your personal details for the quote.

Salutation *

First Name *

Middle Name (Optional)

Last Name *

Email Address *

Mobile Number *

Date of Birth *

Address Details

Where you and the vehicle reside.

Province/Territory *

City *

Street Address *

Postal Code *

Attachments *

Upload your driver's license (required). Provide vehicle registration or bill of sale to confirm ownership.

Upload file

Driver's License

Front & back · JPG or PDF

Required

Upload file

Vehicle Registration

Current year · JPG or PDF

Optional

Upload file

Bill of Sale

If recently purchased

Optional

Vehicle Usage

How you use the vehicle and recent purchase details.

How is this vehicle primarily used? *

Estimated Annual Kilometres *

Additional vehicles & drivers

Other vehicles to include on this quote

Additional drivers

If you recently purchased the vehicle, these details help the broker provide a more accurate quote.

Purchase Date

Ownership & Coverage

Ownership Type *

Desired Coverage Level *

Desired Policy Start Date

Mandatory Ontario Coverages Included

• Third-Party Liability ($1M standard)
• Statutory Accident Benefits (SABS)
• Uninsured Automobile Coverage
• Direct Compensation – Property Damage

Final Details

I understand this application does not bind insurance coverage, and that a licensed broker will contact me to finalize details and pricing.

Why quote with InsuraCan

Secure & Private
Data encrypted, never shared
Compare Multiple Carriers
We shop the market for you
Broker Reviewed
Expert eyes on every policy
Quick Turnaround
Quotes within 24 hours

Trusted Across Canada

500+

Policies

15+

Carriers

50+

Brokers

98%

Satisfaction

Bank-level 256-bit encryption