Request a Quote – Boateng Insurance Financial Services

Auto Insurance

Name *

Email *

Mobile Number *

Driver’Licence *

Driver’Licence 2

Driver’Licence 3

Address *

List of Convictions *

List of Claims *

Prensent Policy and Co. *

Vehicle make, Yr. VIN *

Vehicle *

Home Insurance

Insured 1 *

Insured 2

Present Address *

Insured Property 1 *

Dates of Birth of insureds *

Insureds Profession *

Email *

Mobile Number *

Present Policy and Co. *

Updates on Property

Roof *

Furnace *

Plumbing *

Electricals *

Liability Required *

$1m $2m $5m

Security *

Mortgagee/Landlord Info. *

Commercial Insurance (For Commercial & Non-Profit Organization)

Name of Insured *

Email *

Mobile Number *

Type of Business *

Mailing Address

Business Address *

Risk Explanation *

Contact: Principal /Manager’s Name

Required Liability *

$1m $2m $5m $5m

Annual Receipts($) *

Previous Policy & Co.

Mortgagee/ Landlord/Contractor etc. *

We shall contact you for more information if needed.

Life Insurance

Name Insured 1

Name *

Date of Birth *

Address *

Name Insured 2

Name *

Date of Birth *

Type of Coverage *

Term 10 Term 20 Term 30 Term 40 Whole Life UL

Beneficiaries

Name *

Date of Birth *

Partners buy out Info: *

Comments or other needs *

We shall contact you for more information if needed.

Mortgage Insurance

Name Insured 1

Name *

Date of Birth *

Address *

Name Insured 2

Name *

Date of Birth *

Type of Coverage *

Term 10 Term 20 Term 30 Term 40 Whole Life UL

Beneficiaries

Name *

Date of Birth *

Partners buy out Info: *

Comments or other needs *

We shall contact you for more information if needed.

Living Benefits (Health, Dental, Disability, Critical Illness and Group insurance)

Name Insured 1

Name *

Date of Birth *

Address *

Name Insured 2

Name *

Date of Birth *

Type of Coverage *

Term 10 Term 20 Term 30 Term 40 Whole Life UL

Beneficiaries

Name *

Date of Birth *

Profession: *

Income($) *

Partners buy out Info: *

Comments or other needs *

We shall contact you more for personal information eg. Medical