Please use this form to request changes:

Name of Insured on Policy
Policy Number
1st Insured
Daytime Telephone

2nd Insured
Home Telephone

Any Other Drivers in Household
Any Other Drivers in Household

 

Vehicle Information
Vehicle Year:
Vehicle Make:

Vehicle Model:

Use of Vehicle:

Comments (details if use is other):

Kilometres travelled per year:

How many kilometres one-way for daily commute?

Will this vehicle be used for work-related travel (not including travel to and from the workplace)?

If this vehicle is used for work-related travel, how many kilometers/year (not including travel to and from the workplace)?

Will adding this vehicle result in changes in use of other vehicles owned?

If yes, specify:

Is this vehicle used out of the province more than 30 days/year?

Is this vehicle used for commercial or delivery purposes?

 

Effective Date:
When will this change be effective?

 

About Your Insurance (Specify The Policy To Which This Change Applies)
Company:

Policy Number:

Will this change in use result in changes in use of any other vehicles owned?

If so, please indicate what will change:

 
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.