Replace Vehicle

Tools & Resources

Policy Change Forms – Replace 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 #:


Prior Vehicle


Vehicle make:




New Vehicle


Vehicle make:



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?


Driver Information


(for all drivers who will be operating this vehicle)


Date of birth

Driver type:


Effective Date


When will this change be effective?


About Your Insurance


(Specify the policy to which this change applies)


Policy #:

Additional Comments:

Name of your broker: