Delete Coverage Request Name of Insured on Policy Policy Number 1st Insured Daytime Telephone 2nd Insured Home Telephone Vehicle Information Vehicle Year: Vehicle Make: Vehicle Model: VIN #: Please upload a written letter for any vehicle, driver, or coverage removal. Be sure to include: Description of what item is being deleted (i.e., "2005 Chevrolet Astro" or "Karen Smith as a driver") Reason why item being deleted (i.e., "sold 2005 Chevrolet Astro" or "Karen Smith moved out of my household") Date and signature of all named insureds If you have more than one vehicle, will the deletion of this vehicle result in changes to the way the remaining vehicles are used? YesNo If yes, specify: Effective Date: When will this change be effective? About Your Insurance (Specify The Policy To Which This Change Applies) Company: AvivaRSAWA Policy Number: Are you the named insured? YesNo Additional Comments: I hereby confirm I am the named insured of this policy and as such take full responsibility that the information I am sending is accurate and truthful.