HOME INSURANCE POLICY

DECLARATIONS

POLICY No 252-5817 CAR + HOME

AUTO POLICY E58-3043
POLICY PERIOD
12.01 AM standard time at the address as stated herein
day month year day month year

15 07 2021 15 07 2022

NAME AND ADDRESS OF INSUREDS CUSTOMER SERVICE

OLANIPEKUN TOMORI VENTES/SALES
OMOLOLA TOMORI 1-888-270-9111
7407, MOUNTAIN SIGHTS AV. INDEMNISATION/CLAIMS
APT. 505 1-877-270-9124
MONTREAL, QC H4P 0B6 TEL. (514) 929-0206

RENEWAL
PREMIUM (excluding tax) $231
IN CONSIDERATION OF THE PREMIUM STATED, THE INSURER WILL INDEMNIFY THE INSURED IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE POLICY AND IS SUBJECT TO THE GENERAL CONDITIONS
(FORM 404.0 VERSION 6 ).

INCLUDED! LEGAL AID COVERAGE.

THE INSURED’S DECLARATIONS PERTAINING TO EACH LOCATION ARE DESCRIBED ON REVERSE.

PRINCIPAL LOCATION
ADDRESS 7407, MOUNTAIN SIGHTS AV., APT. 505
MONTREAL, QC H4P 0B6

NAMED INSURED OLANIPEKUN TOMORI

OMOLOLA TOMORI

No. SUMMARY OF COVERAGE FORM DEDUCTIBLE AMOUNT OF PREMIUM

INSURANCE ANNUAL
TENANTS INSURANCE
TOTAL TRANQUILITY PACKAGE

02 PERSONAL PROPERTY 435.9-3 500 23,000 231

AUTOMATIC INFLATION PROTECTION AT A MONTHLY RATE OF 0.20%
REPAIR OR REPLACEMENT COST WITHOUT DEDUCTION
FOR DEPRECIATION
04 ADDITIONAL LIVING EXPENSES 435.9-3 500 6,900
0905 ACCIDENT INSURANCE: LIMIT PER CLAIM 435.9-3 30,000
10 PERSONAL LIABILITY 435.9-3 1,000,000
9608 LEGAL AID COVERAGE 484.2-2

TOTAL PREMIUM FOR THIS POLICY : $231

PRINTED 21-05-2021 C.96-99 SYST

President
Belair Insurance Company Inc.

INSURED - PAGE 1
The rating for this location is based on the following information :
• You have been claims free for the past three years.
• Your dwelling is occupied as a residence.
• There are 50 dwelling unit(s) in the building.
• Your principal heating source is an electrical heating system.
• The building was constructed with fire resistant material.
• Your dwelling is within 300 meters of a fire hydrant.
• Your dwelling is within 8 kilometers of the fire station serving your neighbourhood.
• The dwelling is not a commercial building.
• Your dwelling is not used for any commercial activities.
• You are a Graduate of a University.
If any of the above-mentioned information has changed or if you have renovated this location during the last year, please contact one of our agents at once.
All agents employed by Belair Insurance Company Inc. offer only products from this insurer.

CANCELLATION REQUEST POLICY NO.: 252-5817

In consideration of the return of unearned premium, to follow if any, this policy is hereby cancelled and surrendered, and the interim and renewal certificates, if any for same,
acknowledged to be of no effect.
REASON FOR TERMINATION : Sold or moved Better rates Inadequate service :
(Explain briefly)
Other:
(Explain briefly)

SIGNATURE : CANCELLATION DATE :

Insured

Before deciding to cancel your insurance policy, consult one of our agents for help in determining the most advantageous course of action.