I am doing an Essay on Public VS. Private car insurance in Canada, If any Canadians who Read this would copy and paste this form, then fill it out and submit it as an answer that would be very much appreciated. Also any information you have about public vs. private insurance, such as your person experience’s with them, or how your insurance might vary from the norm would be helpful.
Thank you.

This is an Example Filled out by my Dad:

Insurance information needed

Public or Private Insurance: Private
Insurance Company: Lombard
Age: 55
Gender: Male
number of Traffic Convictions in past 3 years: 1
At Fault Accidents in past 3 years: 0
not at fault in last 3 years: 3
Make: Chrysler
Model: Pacifica
Year: 2004
Rent, Lease or Own: own
Do you have collision?: Yes
if so, then Deductible: 500
License type: G
years licensed: 39
Marital Status: Divorced
Cost per year: $1400

additional Information:
Multi Line Policy: house and car insured for one lump sum

here is the Form to Fill out, Thank you very much again for your help

Insurance information needed

Public or Private Insurance:
Insurance Company:
Age:
Gender:
number of Traffic Convictions in past 3 years:
At Fault Accidents in past 3 years:
not at fault in last 3 years:
Make:
Model:
Year:
Rent, Lease or Own:
Do you have collision?:
if so, then Deductible:
License type:
years licensed:
Marital Status:
public or private:

additional Information:

And I forgot to ask,
Please include the province and town in which you live

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