Welcome to Holman Insurance Brokers on-line Group / Team Insurance quick quote page. Please ensure you complete the form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to one of our sales representatives, please call us at (905) 886-5630 or 1-800-567-1279.

Completion of this form is for informational purposes only, and is just an estimate.
This WILL NOT result in a new policy, or change to an existing policy.

* Required Fields

Contact Information
Company Name*
Contact First Name
Address*
Contact Last Name
City*
Phone*
Province*
Phone 2
Postal Code*
Fax
Web Site
E-Mail*
Please specify your preferred method of contact:
Phone Email
Insurance Information
Are you presently insured? If yes, what company?* (enter "none" if answer is no)
Policy Number* (enter "none" if you do not have a policy number)
Expiry Date
What is your current annual premium?
$
Why are you looking for a new insurer or broker?
Coverage Information
Do you need to name anyone as an additional insured? If yes, please list:
List all sponsored and supervised activities of the named insured including socials, fundraisers, fieldtrips etc:
Activity Information (check all applicable)
Day Camp / Clinic
Overnight Camp
Coaches / Officials Group
Team
League
All Star Game
Officials / Umpire Group
Musical Group
Stage production
Film Production
Volunteer
Other
Sport Information
Ages
Sport
Number of Participants
Claims (Please list all claims in past 5 years.)
Claim
Date of Claim
Claim Payout
Details of Claim
1
2
3
Additional Comments



Please take a moment to tell us how you heard about us:
Thank You

Thank you for trusting Holman Insurance Brokers Ltd. for your insurance needs, one of our representatives will contact you soon with your quote!
Group/Team Quote