JMHI Insurance Group Home Quote Request form

JMHI Insurance Group - 家庭保险报价请求 - 普通话
关于您（房主或租户）的问题 / Questions about you (the homeowner or tenant)
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 Province Postal Code
Date of Birth - must be dd/mm/yyyy format * Required
您的出生日期是什么？ What is your date of birth?
Date Format: DD slash MM 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 say
Cell Phone Number
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?
email@address.net email@address.net
What is your occupation and how long employed? * Required
您的职业是什么？工作了多久？ What is your occupation and how long employed?

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JMHI Insurance Group - 家庭保险报价请求 - 普通话
关于房屋的问题 Questions about the home
Address of the dwelling to be insured * Required
您想要投保的房产地址是什么？（如果适用，请包括单元号） What is the address of the dwelling you want to insure? (include unit # if applicable)

与先前地址相同 Same as previous address

Street Address Address Line 2 City Province Postal Code
Do you rent or own the dwelling? * Required
谁是房屋的所有者? Do you rent or own the dwelling?
- 拥有住房 Own
- 租住房屋 Rent
When did you move in? (Year and month) - must be mm/dd/yyyy format * Required
您是什么时候搬进来的？（年份和月份） When did you move in? (Year and month)
Date Format: MM slash DD slash YYYY
List everyone on the deed or lease agreement, fill in full legal name and date of birth
列出房契或者租约上的所有人，填写全名和出生日期 List everyone on the deed or lease agreement, fill in full legal name and date of birth
完整的法定名称 Full Legal Name 出生日期 Date of birth (dd/mm/yyyy)
Phone
This field is for validation purposes and should be left unchanged.

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JMHI Insurance Group Home Quote Request form – Mandarin

完整的法定名称 Full Legal Name	出生日期 Date of birth (dd/mm/yyyy)