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Manulife

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  Health and CI

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13589 Peggy's Cove Road
Upper Tantallon, NS, B3Z 2J3
Phone: 902-826-2508
Fax: 902-826-2965
     
 
Personal Information
First Name:   *
Last Name :   *
Telphone Number :   *
Email Address :   *
Complete Address :   *
Drivers License Master Number :   *
Coverages Required
Third Party Liability :   $1,000,000
Collision - (Deductible) :   $500 $250
Comprehensive - (Deductible) :   $500 $250
All Perils - (Deductible) :   $500 $250
Auto Information
Brand Of Car :  
Model Of Car :  
Vehicle VIN Number :  
Year Of Car :  
Vehicle Usage
Pleasure, Commute or Business use:  
Annual kms :  
kms to work (if applicable):  
Additional Information
Any Accidents in the last 6 years :  
Any Tickets in the last 6 years :  
How did you hear about us?:  
 
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