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Get the best rate on auto insurance in Ontario. For three generations, Mitchell & Whale has been helping Ontario drivers just like you find the best coverage in the province at the most affordable rates.

Mitchell & Whale Insurance Brokers Ltd.
Mitchell & Whale Insurance Brokers Ltd.
Insurance History
If a driver is licensed less than 6 years in Canada, driving experience in other countries may be recognized. Attach proof of other licensing and insurance.
What are the details of the applicant’s most recent automobile insurance?

To the applicant’s knowledge…
Has any driver’s licence, vehicle permit etc, issued to the applicant or to any person in the household or business been suspended or cancelled in the last 6 years?
Has any insurance company cancelled automobile insurance for the applicant or any listed driver in the last 3 years?
During the last 3 years, has any automobile insurance policy issued to the applicant or any listed driver been cancelled or has any claim been denied for material misrepresentation?
Has the applicant or any listed driver been found by a court to have committed a fraud connected with automobile insurance?
Applicant’s Name & Postal Address

Described Automobile
Each automobile will be used primarily in the vicinity of the applicant’s address.

Auto No. 1

Owned? Leased?
Automobile Use
Is any automobile used for car pooling?
Type of Fuel Used
Unrepaired Damage?
Is the applicant both the Registered Owner and the Actual Owner of the described automobile(s)?
Will any of the described automobiles be rented or leased to others, or used to carry passengers for compensation or hire, or haul trailer, or carry explosives or radioactive material?

Driver Information – List all drivers of the described automobile(s) in the household or business

Driver No. 1
Driver Training Certificate Attached?
Date First Licensed in Canada or U.S.
(Class G or equivalent)

Other class of license, If any

Percentage Use by Each Driver

Do any drivers qualify for Retiree Discount?

Are any other persons in the household or business licensed to drive?
Previous Accidents and Insurance Claims
Give details of all accidents or claims arising from the ownership, use or operation of any automobile by the applicant or any listed driver during the last 6 years.

Accident No. 1

Coverage Claim Paid Under

History of Convictions
Give details of all convictions of the applicant and any listed driver arising from the operation of any automobile in the last 3 years.

Conviction No. 1

Attached files
  • No Files

Please call 8007312228 Monday to Friday 8am to 8pm, to review your record with a broker to receive a quote

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To get a quote on Ontario auto insurance, or to find out more about your coverage options, contact us or call us at 1-800-731-2228.

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