JMHI Insurance Group Auto Quote Request - Mandarin Auto insurance questionnaire for JMHI Insurance Group 汽车保险调查问卷 JMHI Insurance Group Step 1 of 4 25% Full Name * Required您的名字是什么？ What is your legal name? 名字 Given Name 姓 Family Name Home Address * Required您的家庭住址是什么？（如果适用，请包括单元号） What is your home address (include unit # if applicable)? Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth - must be mm/dd/yyyy format * Required您的出生日期是什么？ What is your date of birth? Date Format: MM slash DD slash YYYY What is your gender * Required您的性别是什么？ What is your gender?男 Male女 Female保密 Prefer not to sayMarital Status * Required您是已婚还是单身？ Are you married or single? 已婚 Married单身 SingleCell Phone Number * Required您的电话号码是什么？ What is your phone number? Email * Required您的电子邮件地址是什么？ What is your email address? Enter Email Confirm Email Retirement status您是否退休？（可能有资格享受退休人员折扣） Are you retired? (May be eligible for retiree discount)是的 Yes不是 NoStudent status您是学生吗？（可能有资格享受优秀学生折扣） Are you a student? (May be eligible for a good student discount)是的 Yes不是 No 关于您的驾驶记录的问题 Questions about your driving record Driver’s license number * Required您的驾照号码是什么？ What is your driver’s license number? Ontario G1 Licensing Date - must be mm/dd/yyyy format您在什么日期获得了安省 G1 驾照？ What dates did you get Ontario G1 license? Date Format: MM slash DD slash YYYY Ontario G2 Licensing Date - must be mm/dd/yyyy format您在什么日期获得了安省 G2 驾照？ What dates did you get Ontario G2 license? Date Format: MM slash DD slash YYYY Ontario G License Date - must be mm/dd/yyyy format您在什么日期获得了安省 G 驾照？ What dates did you get Ontario G license? Date Format: MM slash DD slash YYYY Government approved driving training course? * Required您是否参加过由政府认可的驾驶培训课程? Have you ever attended a government-approved driving training course?是的 Yes不是 NoGovernment approved driving training course date - must be mm/dd/yyyy format * Required如果有,请填写培训时间。 If yes, please fill in the training date. Date Format: MM slash DD slash YYYY First Canadian license date - must be mm/dd/yyyy format您第一次在加拿大获得驾照是什么时候？ When did you first become licensed in Canada? Date Format: MM slash DD slash YYYY First time insured in Ontario - must be mm/dd/yyyy format您第一次在加拿大投保是什么时候？ When were you first insured in Ontario? Date Format: MM slash DD slash YYYY Are you currently insured in Ontario? * Required您目前在安大略省有保险吗？ Are you currently insured in Ontario?是的 Yes不是 NoName of your current insurance company您当前的保险公司名称是什么？ What is the name of your current insurance company? How long have you been with your current insurer?您在当前保险公司投保多久了？ How long have you been with your current insurer?When does your current policy expire? - must be mm/dd/yyyy format当前保险的过期时间？ When does your current policy expire? Date Format: MM slash DD slash YYYY Has an insurer cancelled your policy? * Required在过去的6年中，保险公司是否取消过您的保单？ Has an insurer cancelled your policy in the last 6 years? 是的 Yes不是 NoWhat was the reason for cancellation? * Required原因是什么？ What was the reason? Any collisions in the last 6 years? * Required在过去的6年中，您的记录上是否有任何事故？ Do you have any accidents on your record in the past 6 years?是的 Yes不是 NoList collisions * Required无论是否是您的责任。 Please list all claims whether your fault or not. Ever had a claim denied for fraud? * Required您是否曾因欺诈或虚假陈述而被拒绝索赔？ Have you ever had a claim denied for fraud or misrepresentation?是的 Yes不是 NoSuspended license in the last 6 years? * Required在过去的6年中，您的驾照是否被吊销过？ Has your license been suspended in the last 6 years?是的 Yes不是 NoReason for suspended license?吊销执照的原因是什么？ What was the reason for the suspended license?Minor traffic convictions? * Required您的驾驶记录上是否有任何交通违章（在过去3年内被判定）？ Do you have any minor traffic convictions (tickets) on your driving record(convicted in the last 3 years)?是的 Yes不是 NoMajor criminal code convictions? * Required您是否有任何与交通相关的刑事犯罪记录（如酒驾）？ Do you have any traffic-related major criminal code convictions (like impaired driving)?是的 Yes不是 No 关于您的车辆的问题 Questions about your vehicleNew or Used at time of purchase or lease? * Required您最初租赁或购买车辆时是新车还是二手车？ Was it new or used when you originally leased or purchased it?新的 New二手的 UsedLeased, financed or own vehicle? * Required车辆是租赁的、贷款的还是完全拥有的？ Is the car leased, financed or owned？租赁 Leased贷款 Financed拥有 OwnedDate you purchased or leased the vehicle? - must be mm/dd/yyyy format * Required您最初购买或租赁车辆是什么时候？ When did you purchase or lease the vehicle? Date Format: MM slash DD slash YYYY Purchase price * Required您的车辆购买金额？单位为加元。 How much did you purchase your vehicle? In Canadian Dollars.Please enter a number from 0 to 10000000.Vehicle Identification Number - VIN * RequiredVIN number VIN 号码Year, Make, and Model of Vehicle * Required您的车辆的年份、品牌和型号是什么？ What is the year, make and model of the vehicle?Winter Tires * Required您在冬季是否为车辆安装雪地轮胎？ Do you put snow tires on your vehicle during the winter months?是的 Yes不是 NoAnti-Theft Device * Required你们有防盗装置吗？ Do you have an anti theft device?是的 Yes不是 NoAnti-Theft Device details请提供有关防盗装置的详细信息，包括制造商。 Please provide details about the anti-theft device including manufacturer.Anti-Theft Device details请提供有关防盗装置的详细信息，包括制造商。 Please provide details about the anti-theft device including manufacturer.TAGHonda/Acura LocateKYCSDominoMonthly or Annual payment * Required您会按月还是按年支付？（如果按年支付，可能会有折扣） Will you be paying monthly or annually? (you may give discounts if you pay annually)按月 Monthly按年 AnnuallyAddress Where vehicle is parked车辆将停放在什么地址？ 示例：邮寄地址是一个地点，但车辆在学校使用。 What is the address where the vehicle will be parked? Example: Mailing address is one location but vehicle is used at school. 与家庭住址相同 Same as home address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code 关于您的驾驶习惯的问题 Questions about your driving habitsUsing for work or school? * Required您是否会使用车辆上下班或上下学？ Will you be using the vehicle for driving back and forth to work or school?是的 Yes不是 No工作和学校 Both work and schoolNumber of Kilometers - one way * Required如果是，单程有多远, 以公里为单位？ If so, how far is it one way, in kilometers?Please enter a number less than or equal to 1000.Annual Kilometers * Required您每年行驶多少公里？ How many kilometers do you drive annually?Please enter a number less than or equal to 1000000.Commercial use? * Required您是否会将车辆用于任何商业用途？ Will you be using the vehicle for any business or commercial use?是的 Yes不是 NoSpecific commercial purpose? * Required如果是，商业用途占车辆使用的百分比是多少？具体的商业用途是什么？ If so, what percentage of vehicle use is for business? What is the specific commercial purpose?HAB Insurance * Required您目前有租客或房屋保险吗? / Do you currently have tenants or home insurance? 是的 Yes 不是 No CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Previous Post JMHI Insurance Group Auto Quote Request form Next Post JMHI Insurance Group Home Quote Request form – Mandarin
