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Tools and Resources

Policy Change Forms - Add Vehicle

For your added protection, changes made to your policy do not become effective until we contact you to verify the change and effective date. This is to protect your existing coverage, should additional information or coverage be required to make the change you have asked.
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(dd/mm/yy):
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 whether leased or financed:
Names and address of leasing company lien holder:
Use of vehicle:
Comments (details if use is other):
Kilometres traveled per year:
How many kilometers one-way for daily commute?
Will adding 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  Higher
Comprehensive coverage and deductible requested:
No Coverage
Yes - deductible
(min) $300  $500  Higher
All perils coverage and deductible requested:
No Coverage
Yes - deductible
(min) $500  $1000  Higher
   
Driver Information  
(for all drivers who will be operating this vehicle)
Driver #1 Driver #2 Driver #3
Driver:
Date of birth (dd/mm/yyyy):
Driver type:
   
Effective Date  
When will this change be effective? (dd/mm/yyyy):
   
About Your Insurance
(Specify the policy to which this change applies) 		 
Company:
Policy #:
Additional Comments:
Name of your broker:
   
 



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