Personal Auto Proposal | Wilson Insurance

Request an insurance proposal for your personal automobile.

Click to open/close each section and enter required information. Time to complete: less than 5 minutes

Step # 1 of 5 - Personal and contact information

COMPLETE SECTION # 1 - PERSONAL INFORMATION

Thank you for requesting an Auto Quote from Wilson Insurance. Simply complete the following form for a Free No Obligation Quote and an Account Executive will be in contact to explain coverage options and discuss your quote.

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Your contact information will be kept private and secure.

First Name: *

Last Name: *

Postal Code: *

Canadian Residents Only! - Atlantic Provinces

Daytime telephone number: *

Email address: *

What is the best way to contact you: *

Step # 2 of 5 - Driver information

Name: Driver # 1: *

Date of Birth (Month/Date/Year): Driver #1: *

Date First Licensed (Month/Date/Year): Driver # 1 :

Marital Status: Driver #1:

Has Driver # 1 completed an approved defensive driving course?:

Has Driver # 1 had any responsible accidents or claims in the past 10 years?:

If yes, please describe:

Has Driver #1 had any convictions in the past 10 years?:

If yes, please describe: :

In the past 10 years has Driver # 1 had their license suspended or revoked?:

In the past 3 years has Driver #1 had insurance cancelled for non-payment of premium?:

Click here to enter information for driver # 2

Name: Driver # 2: *

Date of Birth (Month/Date/Year): Driver #2: *

Date first licensed (Month/Date/Year): Driver #2:

Relationship: Driver # 2 :

Has Driver # 2 completed an approved defensive driving course?:

Has Driver #2 had any responsible accidents or claims in the past 10 years?:

If yes please describe:

Has Driver #2 had any convictions in the past 10 years?:

If yes, please describe:

In the past 10 years has Driver #2 had their license suspended or revoked?:

In the past 3 years has Driver #2 had insurance cancelled for non-payment of premium?:

Click here to enter information for driver # 3

Name: Driver # 3 : *

Date of Birth (Month/Date/Year): Driver #3: *

Date 1st licensed: Driver #3:

Relationship: Driver #3:

Has Driver #3 completed an approved defensive driving course?:

Has Driver # 3 had any responsible accidents or placed any claims in the past 10 years?:

If yes, please describe::

Has Driver #3 had any convictions in the past 10 years?:

If yes, please describe:

In the past 10 years has Driver #3 had their license suspended or revoked?:

In the past 3 years has Driver #3 had insurance cancelled for non-payment of premium?:

Click here to enter information for driver # 4

Name: Driver #4:

Date of Birth (Month/Date/Year): Driver #4:

Date 1st licensed: Driver #4:

Relationship: Driver #4:

Has Driver #4 completed an approved defensive driving course?:

Has Driver # 4 had any responsible accidents or claims in the past 10 years?:

If yes please describe: :

Has Driver #4 had any convictions in the past 10 years?:

If yes, please describe:

Has Driver # 4 had their license suspended or revoked in the past 10 years?:

In the past 3 years has Driver #4 had insurance cancelled for non-payment of premium?:

Step # 3 of 5 - Vehicle Information

Make: *

Model: Please include # of doors: *

Year: *

Vehicle Identification Number (VIN) -(Optional) :

Purchase date of vehicle #1:

Who is the primary driver of this vehicle?:

How is this vehicle used most of the time?:

Distance (one way) to work or school: * kms

Annual kilometres: * kms

Would you like comprehensive coverage included on this vehicle :

Comprehensive coverage includes things like theft or other damage not caused by a collision with another vehicle.

Would you like collision coverage included for this vehicle: :

Click here to enter information for vehicle # 2

How is Vehicle #2 used most of the time:

Make - Vehicle #2:

Model: Vehicle #2 - Please include # of doors:

Vehicle Identification Number (VIN) - Vehicle # 2 (Optional):

Purchase date of vehicle #2:

Who is the primary driver of Vehicle #2?:

Year - Vehicle #2:

Distance (one way) to work or school for Vehicle #2: kms

Vehicle # 2 annual kilometres: kms

Would you like comprehensive coverage includied on Vehicle #2?:

Comprehensive coverage includes things like theft or other damage not caused by a collision with another vehicle.

Would you like collision coverage included for Vehicle #2?:

Click here to enter information for vehicle # 3

Make - Vehicle #3:

Model: Vehicle #3:

Year - Vehicle #3:

Vehicle Identification Number (VIN) for Vehicle # 3 (Optional):

Purchase date of vehicle #3:

Who is the primary driver of Vehicle #3?:

How is this Vehicle #3 used most of the time?:

Vehicle #3 Distance (one way) to work or school: kms

Vehicle # 3 annual kilometres: kms

Would you like comprehensive coverage included on Vehicle #3?:

Comprehensive coverage includes things like theft or other damage not caused by a collision with another vehicle.

Would you like collision coverage included on this vehicle?:

Click here to enter information for vehicle # 4

Make- Vehicle #4:

Model: Vehicle #4: Please include # of doors:

Year - Vehicle #4:

Vehicle # 4 Vehicle Identification Number (VIN) (Optional):

Purchase date of vehicle #4:

Vehicle # 4 primary use:

Vehicle # 4 annual kilometres: kms

Vehicle # 4 distance (one way) to work or school: kms

Would you like comprehensive coverage included on this vehicle?:

Would you like collision coverage included for Vehicle #4?:

Step # 4 of 5 - Protection Review

COMPLETE SECTION # 4 - PROTECTION REVIEW

In order to properly protect your assets, its important that we have complete information about your total account. Some of the questions determine if you are eligible for group rates or premium discounts.

Employer: *

Occupation: *

When does your home policy expire:

Who is your current company for homeowners insurance:

Step # 5 of 5 - Comments and approval

COMPLETE SECTION # 5 - COMMENTS & APPROVAL

Comments and questions (optional):

How did you hear about us?: *

Thank you for requesting an online quote from Wilson Insurance Ltd. An Account Executive will be in contact to discuss the quote and coverages with you.