Add a Vehicle

Tools & Resources

Policy Change Forms – Add a Vehicle


About You:

 

Name(s) of insured(s):

1st insured:

2nd insured:

How can we reach you?    

E-mail address:

Daytime telephone #:

Home telephone #:

Fax #:

 

New Vehicle

 

Vehicle make:

Year:

Model:

Condition at time of purchase:    

Purchase date:

Purchase price:

VIN (vehicle ID #):

Any non-factory modifications to the vehicle?

 

Any unrepaired damage?

If yes, specify:

Is vehicle leased or financed?

If yes, specify:

Name of registrant:

Use of vehicle:    

Comments (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?

 

Third party Liability coverage requested:    

 

Collision coverage and deductible requested:

 

Comprehensive coverage and deductible requested:

 

All perils coverage and deductible requested:

 

Driver Information

 

(for all drivers who will be operating this vehicle)

Driver:

Date of birth

Driver type:

 

Effective Date

 

When will this change be effective?

 

About Your Insurance

 

(Specify the policy to which this change applies)

Company:

Policy #:

Additional Comments:

Name of your broker: