Skip to Navigation



RECREATIONAL VEHICULES PROGRAM

Information on the person who owns the recreational vehicle, motor vehicle, fifth-wheel trailer, trailer, tent trailer, park model trailer, or stationary trailer.

First Name
City
Last Name
Address
Phone Number Postal Code
Phone (office) Email Address
FQCC Member Age

Information on the recreational vehicle, motor vehicle, fifth-wheel, trailer, tent trailer, park model trailer, or stationary trailer.

Classe A Classe B Classe C 5th wheel
Roulotte Tente-roulotte Roulotte parc Stationnaire
Make Model
Year Price when new (excluding tax)
Length Purchase price (excluding tax)
How long have you had an RV? Is the RV on wheels?

In answering the following questions, keep in mind that they pertain only to your experience with insurance for RVs, recreational vehicles, or motor vehicles.

For the three (3) most recent years, indicate:

Whether your licence has been revoked or suspended,
or if you have been found guilty of a criminal infraction.
Number of violations
less than 3 points
Number of violations
greater than 3 points

Claims filed during the past six (6) years for the recreational vehicle (including glass breakage, theft, no-fault claims, etc.)

Type of claims Date Liability Driver
Additional discounts
Occupation Employer

So as to determine your premium using the best possible conditions, may we have your permission to verify your credit and accident histories with companies that specialize in retaining such information?

Recreational Vehicle Coverage
Civil liability: B-1 All risks (except): Replacement value: Depreciation waiver:
Date of your RV renewal:
Name of your current (RV) insurer:
Residence renewal:
Comments:
Please contact me



Go to the navigation