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About
- Our Team
Contact

Keyes Insurance Brokerage Limited: Keyes Insurance Brokerage Limited is directly owned by McDougall Insurance Brokers Limited. Definity Insurance Company o/a Economical Insurance, indirectly owns a majority interest in McDougall Insurance Brokers Limited, and from time to time, provides loans and other financial assistance to McDougall Insurance Brokers Limited in support of its business.

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Policy Change Forms
Replace a Vehicle

Replace a Vehicle

Vehicle Policy Change form from Keyes Insurance

Replace a Vehicle is a type of Policy Change form from Keyes Insurance Brokerage, where you can replace a vehicle from your existing insurance policy.

Name of 1st insured:*
Name of 2nd insured:
How can we reach you?*
- Phone
- Email
Phone*
Email*
Prior Vehicle
Vehicle make*
Year*
Model*
New Vehicle
Vehicle make*
Year*
Model*
Condition at time of purchase*
Purchase date*
MM slash DD slash YYYY
Purchase price
VIN (vehicle ID #)
Any non-factory modifications to the vehicle?*
- Yes
- No
Any unrepaired damage?*
- Yes
- No
If yes, specify
Is vehicle leased or financed?*
- Yes
- No
If yes, specify
Name of registrant
Use of vehicle*
Details if use is other
Kilometres traveled per year:*
How many kilometers one-way for daily commute?*
Will replacing this vehicle result in changes in use of other vehicles owned?*
- Yes
- No
Third party Liability coverage requested*
Collision coverage and deductible requested*
- No Coverage
- Yes - deductible (min) $500
- $1000
Comprehensive coverage and deductible requested*
- No Coverage
- Yes - deductible (min) $300
- $500
All perils coverage and deductible requested*
- No Coverage
- Yes - deductible (min) $500
- $1000
Driver Information
(for all drivers who will be operating this vehicle)
Driver*
Date of birth*
MM slash DD slash YYYY
Driver type #1*
- Principal
- Occasional
Driver
Date of birth
MM slash DD slash YYYY
Driver type #2
- Principal
- Occasional
Driver
Date of birth
MM slash DD slash YYYY
Driver type #3
- Principal
- Occasional
Effective Date
When will this change be effective?*
MM slash DD slash YYYY
About Your Insurance
Company*
Policy #*
Name of your broker
Additional Comments

Office
Keyes Insurance
1658 Bedford Hwy Suite 2260,
Bedford, NS B4A 2X9,
(Bedford Place Mall 2nd Level)
Contact
Call Us: (902) 453-2273
1 (888) 433-6771 (toll free)
(902) 453-6668 (fax)

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Friday: 9:00 am to 4:00pm
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Keyes Insurance Brokerage Limited: Keyes Insurance Brokerage Limited is directly owned by McDougall Insurance Brokers Limited. Definity Insurance Company o/a Economical Insurance, indirectly owns a majority interest in McDougall Insurance Brokers Limited, and from time to time, provides loans and other financial assistance to McDougall Insurance Brokers Limited in support of its business.

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Replace a Vehicle

Vehicle Policy Change form from Keyes Insurance

Prior Vehicle

New Vehicle

Driver Information

Effective Date

About Your Insurance