Primes

Contractor

Add Contractor

Identification

First name (such as on the driving licence)

Last name (such as on the driving licence)

Mailing address

You must specify the address of your principal residence. If you are insuring a cottage or other residence, the address will be requested in a later section.

Street Number

Appartment

Postal code

Street

City

Since when do you live at this address?

Current situation?

Are the people you live with homeowners or tenants?

Phones

Primary phone/mobile

You will automatically receive your offers by email. Would you also like to receive them by text message (SMS)?

Other

Renewal date or next purchase date

Please provide the renewal date of your insurance or your next purchase. This is the deadline that insurers have to calculate your premium and make you an offer. However, they can not guarantee their prices more than three months in advance.

Renewal date of your insurance or your next purchase

Reason for requesting a quote

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Driver 1

Add a driver

Delete a driver

Driver identification

First name (as on the driving licence)

Last name (as on the driving licence)

Birthdate

Gender

Marital Status

Relationship to applicant

Level of education

Level of education completed

Occupation

Industry

Job

Associations

If you are a member of an association or university, it is important to mention it here. Discounts may apply. Please enter the name of your association. Includes groups that may apply to you or to a person at your address. Examples: Student Association, professional, club of the golden age, Zec, etc.

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The list does not contain all the existing associations. If the system does not find it, leave this field blank.

Criminal record

Have you or anyone living with you been convicted of a criminal offense?

Who has been convicted?

Reason of your criminal record

Credit Record

In order to establish the best possible premiums and conditions, will you allow ClicAssure and its partners to check this driver's credit file?

Reply YES will not affect the credit.

Reply NO could result in a premium increase and / or a refusal to get monthly payments.

Do you allow ClicAssure and its partners to check a driver's credit file?

Insurance

How many years has this driver been insured on a vehicle?

Current Insurer

How many years has this driver been insured with this insurer?

Licence Suspensions

If this driver's licence has been suspended, canceled or revoked within the last 6 years, please provide details.

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Tickets

If this driver has had tickets other than parking within the past 3 years, please provide details.

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Licence information

Approved Canadian driver training course completed?

Do you have your driver licence for more than five years?

Current licence

At what age did you get your driver's training course?

At what age did you get your Québec driver's licence?

Claims

If this driver has made claims (including unreported accidents) within the last 6 years, please provide details.

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Car 1

Add Car

Delete Car

Make and Model

The VIN is not mandatory, however, providing it will more specifically identify the vehicle, streamline the submission process, and enable a more accurate risk assessment.
IF YOU DON'T KNOW YOUR VIN simply move to the next field (Year).

Vehicle Identification Number (VIN)

optionnal

Vehicle

Year

Make

Model

Purchase Date

Current value of the vehicle

Is the vehicle leased?

Condition of vehicle on takeover date

Mileage on takeover date

Vehicle financing

Usage

Actual annual cost of your insurance tx in. (optional)

If this vehicle is currently insured, enter the annual premium including tax.

Primary use

Number of km traveled annually

Where is this vehicle parked in the daytime?

Where is this vehicle parked overnight?

Other Informations

Has the vehicle been in a serious accident or rebuilt?

Is this vehicle currently insured with a Waiver of Depreciable coverage?

Is this vehicle currently uninsured for more than 10 days and insurers refuse to provide coverage?

Has the vehicle been modified for performance at a gost greater than $1000?

Has the appearance of the vehicle been modified at a cost greater than $1000?

Is it used for the transport of commercial goods (i.e. Restaurant delivery, courier service, etc ...)?

Electronic accessories (i.e. audio system or navigation system) added to factory installed components?

Is the vehicle used outside the province?

Anti-theft Systems

Is this vehicle equipped with a Tracking System?

Coverages

Col.

Collision

Comp.

Comprehensive

20A

Complete Popular (2 sides)

2M$

500$

250$

Choose

Complete Thrifty (2 sides)

2M$

1000$

500$

Choose

Col.

Comp.

20A

Basic Popular (1 side)

2M$

Excluded

500$

Choose

Basic Thrifty (1 side)

2M$

Excluded

Choose

Legend

TP: Third Party Liability

Collision: Collision or Upset

Comprehensive: Comprehensive Protection

20A: Loss of Use (broad form)

34: Injured Persons - Accident Benefits

27: Legal Liability for Damage to Non-Owned Automobile

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Finalize

Add Finalize

Additional Information

Please specify any information that you feel is relevant to the insurers who will receive your request.

Survey

How did you hear about us?

Subscriptions

Select the services you want. These services are free and are intended to inform and save you time and money. Note that you can unsubscribe at any time.

Renewal Reminder

Do not forget to shop your insurance before your next renewal. Subscribe to receive a reminder before the due date of your policy, and we will send you an email to give you time to shop around to get the best rates.

Newsletters and promotional offers

To receive last minute information and articles helping you to save.

Create client profile

Will allow you to see your submissions and forms in one place.

Choice a password

Confirm password

* Please note that you may receive emails at any time from ClicAssure and its partners in the context of your request.

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CAR INSURANCE

Contractor

Identification

Manual email validation required

Mailing address

Previous Address

Phones

Renewal date or next purchase date

Driver 1

Driver identification

Level of education

Occupation

Associations

Criminal record

Credit Record

Credit Record

Insurance

Insurance Cancellation

Licence Suspensions

Tickets

Licence information

Claims in the Central File

Claims

Car 1

Make and Model

Usage

Other Informations

Anti-theft Systems

Coverages

Finalize

Discount

Additional Information

Survey

Subscriptions

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	Client The customer portal allows you to create and manage your insurance requests. Use this link if you are a consumer of ClicAssure services.

	Insurer The insurer portal allows clicassure partners to connect and manage the requests assigned to them. Use this link if you are a ClicAssure partner.

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CAR INSURANCE

Contractor

Identification

Manual email validation required

Mailing address

Previous Address

Phones

Renewal date or next purchase date

Driver 1

Driver identification

Level of education

Occupation

Associations

Criminal record

Credit Record

Credit Record

Insurance

Insurance Cancellation

Licence Suspensions

Tickets

Licence information

Claims in the Central File

Claims

Car 1

Make and Model

Usage

Other Informations

Anti-theft Systems

Coverages

Finalize

Discount

Additional Information

Survey

Subscriptions

Dev commands

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