Request for High Net Worth Quote

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Please provide us with the following information and a client manager will contact you 30-60 days prior to the expiry dates of your current policies to provide you with a quote. If your insurance renews in the next 60 days, please call us for a quote at
1-800-385-6619.

Note: Blue labels indicate required entry fields.


First Name:

Last Name:

Street Address:

City:

Province:

Postal Code:
Primary Phone:
   Type:
Secondary Phone:
   Type:

Fax Number:

Email Address:

How did you hear about us?

Do you currently have an insurance policy with PCS?


Automobile Expiry Date:

Month Day Year

Please note that automobile insurance is not available in provinces where government automobile plans exist.

Residential Expiry Date:

Month Day Year


Additional comments or questions:

PRIVACY: Marsh believes strongly in protecting your privacy and the confidentiality of your Personal Information. We acknowledge that you may have privacy and security concerns with respect to the information we collect, use and disclose to third parties for the purpose of allowing us to provide and offer our products and services to you. In order to comply with privacy legislation, we have developed a Privacy Policy which is available at www.marsh.ca. By submitting the above information you are acknowledging that you have read the Privacy Policy and that you consent to the collection, use, disclosure and retention of your Personal Information as set out in the Privacy Policy.