Ivari Missing QuestionsName* First Last TravelI.13 With the exception of travelling 6 months or less per year within North America, the Caribbean or European Union countries, do you have any plans to travel or reside outside of Canada in the next 12 months?*YesNoIf “Yes”, provide details: countries, cities, purpose of travel, length of stay and expected number of trips per year.*City and CountryPurpose of Travel# of times per yearLength of Stay Lifestyle and AvocationI.14 Are you using a wearable fitness tracker to track calories burned, steps taken, heart rate measured, hours slept, etc.? If “Yes”, would you be willing to share the data you collected with ivari (If willing please attach data collected to your insurance application)?*YesNoI.15 In the last 12 months, have you piloted an aircraft other than with a commercial/major airline carrier or do you intend to do so in the next 12 months? If “Yes”, complete the Aviation Questionnaire.*YesNoI.16 In the last 12 months, have you engaged in any hazardous or extreme sports (including, but not limited to mixed martial arts, combat sports, ski jumping, bungee jumping, base jumping, motorized vehicle racing, cliff diving, scuba diving, sky diving, parachuting, sky surfing, hang-gliding and mountain climbing, out of bound snowmobiling, out of bound skiing), or do you intend to do so in the next 12 months?*YesNoIf yes, do you intend to do so in the next 12 months?* Motorized Vehicle Racing Mountaineering Scuba Diving Other (Complete the appropriate questionnaire or provide additional details)Provide additional details*I.17 In the last 10 years, have you had your driver’s license suspended or revoked?*YesNoDriver’s License No.*Provide reason(s), date(s) and type(s) of offence(s).*Date(s) (DD/MM/YYYY)Details I.18 In the last 2 years, have you refused to provide a breathalyzer sample, and/or have you had 2 or more highway traffic violations?*YesNoDriver’s License No.*Provide reason(s), date(s) and type(s) of offence(s).*Date(s) (DD/MM/YYYY)Details I.19 In the last 10 years, have you been convicted of any criminal offence or fraudulent financial charges or do you have any charges pending?*YesNoProvide reason(s), date(s) and type(s) of offence(s).*Date(s) (DD/MM/YYYY)Details I.20 In the last 5 years, have you filed for bankruptcy and not received a discharge, or are you currently involved in a bankruptcy proceeding?*YesNoProvide details.*CAPTCHA
