Off-Road Dirt Bike Insurance Form

Dirt Bike Insurance Form

"*" indicates required fields

Step 1 of 7 - page 1

Tell us about your Dirt Bike

Vehicle year*

Vehicle make*

Specify make*

Vehicle model*

e.g. CRF125F, V-Strom 650, etc.

Enter vehicle VIN (optional)

e.g. 1V1FZ1FK7NU5XXXXXX

Name*

First Last

Phone number*

Address where vehicle is kept?*

e.g. 10 Water Street, Somecity, ON. A1A 1A1

When would you like coverage to begin?*

MM slash DD slash YYYY

How we collect and use your information*

GETRATES collects, uses, and discloses the personal information you provide for yourself, and that we receive from third parties, to assess your insurance needs, offer you an insurance quote, analyze the use of this quote service, and prevent fraud.

I agree

Select Year Select Make,

Policy Holder -

tell us about your off-road dirt bike

Do you own, lease, or finance your off-road dirt bike?*

Own

Lease

Finance

What month and year did you buy your off-road dirt bike?*

MM slash DD slash YYYY

What month and year did you lease/finance your off-road dirt bike?*

MM slash DD slash YYYY

What was the total value of your off-road dirt bike when you bought it?*

What was the total value of your off-road dirt bike when you leased/financed it?*

Was your vehicle was new or used?*

Was your vehicle new or used?

Choose New if you’re the first owner of this vehicle. You can also choose New if you bought a demo vehicle from a dealership and it had less than 10,000 km on it.

If you’re not the first owner of this vehicle, or if it was a demo vehicle that had more than 10,000 km on it when you bought it, choose Used.

New

Used

Select Year Select Make,

Policy Holder -

please tell us about yourself

Date of Birth*

Month*

Year*

Sex*

Why do we ask about your sex?

When you tell us the sex listed on your licence, we can give you the most accurate quote.

If you identify as nonbinary or Gender X, contact one of our licensed insurance representatives to get a quote that’s just right for you.

Male

Female

Marital status*

For insurance purposes, common law means an unmarried couple has lived together for at least one year.

Choose Married/Common Law if you are widowed.

Single

Married/Common Law

Email*

Consent*

I consent to receive communication by email or phone from GETRATES. I can opt out at any time by following the instructions at the bottom of the email I receive.

Yes

Select Year Select Make,

Policy Holder -

Tell us about your driving history

Enter your driver’s licence number (optional).

By entering your driver’s licence, you consent to the disclosure of your driver’s licence number to GETRATES in order for our brokers to obtain a driver history report, which contains information about your past automobile claims and policies.

What is your current licence class?*

What is a licence class?

The licence class tells us how experienced a driver is.

G: Fully licensed driver
G2: Second-level learner who can drive alone with some conditions
G1: First-level learner with the most conditions; can’t drive alone
M: Fully licensed driver
M2: Second-level learner
M1: Learner
M-M: Fully licensed driver with M condition for three-wheeled motorcycles
M2-M: Second-level learner with M condition for three-wheeled motorcycles
M-L: Fully licensed driver with L condition for moped and scooters
M2-L: Second-level learner with L condition for moped and scooter

You can find this information on the front of your licence card.

Select the licence class for the type of vehicle you selected for this quote.

How old were you when you were first licensed to drive alone in Canada (G2 if graduated licensing)?*

If you went through graduated licensing, enter the age you were when you earned your G2. If not, enter the age you were when you earned your G licence.

How old were you when you earned your learner's licence?*

How old were you when you earned this licence?*

This field is hidden when viewing the form

What month were you licensed to drive alone?*

This field is hidden when viewing the form

What month did you earn this licence?

Did you earn a G1 licence?*

Yes

G1 is the first level you earn under the graduated licensing system, which started in April 1994. If you didn't participate in the graduated licensing program, select No.

Have you had any of the following? (Check all that apply):

Accidents or claims in the past 10 years.

Tickets or convictions in the past 3 years, not including parking tickets.

Your licence suspended in the past 3 years.

Select Year Select Make,

Policy Holder -

let's review your drivers

Include any drivers that live with you or use your off-road dirt bike regularly.*

Add another driver

No one else to add

Select Year Select Make,

Adding additional driver

, what rider do you want to add?

Enter additional drivers name*

First Name Last Name

Date of birth*

MM slash DD slash YYYY

Sex*

Male

Female

Marital status*

For insurance purposes, common law means an unmarried couple has lived together for at least one year.

Choose Married/Common Law if you are widowed.

Single

Married/Common Law

Select Year Select Make,

Adding additional driver

Tell us about 's driving history?

Enter their driver’s licence number (optional).

By entering the driver’s licence of the additional driver, you certify that you have obtained their consent to disclose their driver’s licence number to GETRATES. in order to obtain a driver history report, which contains information about their past automobile claims and policies.

What is their current licence class?*

Select the licence class for the type of vehicle you selected for this quote.

How old were they when they were first licensed to drive alone in Canada (G2 if graduated licensing)?*

If this driver went through graduated licensing, enter the age they were when they earned their G2. If not, enter the age they were when they earned their G licence.

How old were they when they earned their learner's licence?*

How old were they when they earned this licence?*

This field is hidden when viewing the form

What month were you licensed to drive alone?*

Have you had any of the following? (Check all that apply):

Accidents or claims in the past 10 years.

Tickets or convictions in the past 3 years, not including parking tickets.

Your licence suspended in the past 3 years.

Dirt Bike Insurance Form

Tell us about your Dirt Bike

Select Year Select Make,

tell us about your off-road dirt bike

Select Year Select Make,

please tell us about yourself

Select Year Select Make,

Tell us about your driving history

Select Year Select Make,

let's review your drivers

Select Year Select Make,

, what rider do you want to add?

Select Year Select Make,

Tell us about 's driving history?

Our Email:

Our number:

Our Address:

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