Policy Change Forms
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Change Vehicle Use
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Policy Change Forms - Change Use of a Vehicle
About You
Name(s) of insured(s):
1
st
insured:
2
st
insured:
How can we reach you?
E-Mail
Phone
E-mail address:
Daytime telephone #:
Home telephone #:
Fax #:
Vehicle Information
Vehicle make:
Year:
Model:
Use of vehicle:
Pleasure
Commuting
Business
Farming
Other
Comments (details if use is other):
Is this vehicle used out of the province more
than 30 days/year?
Yes
No
Is this vehicle used for commercial or delivery
purposes?
Yes
No
Kilometres traveled per year:
0-5000
5001-10000
10001-15000
15001-20000
20001-25000
25001-30000
30001-over
How many kilometers one-way for daily commute?
N/A
0-9
9-16
17-24
25-34
35-50
50+
If this vehicle is used for work-related travel, how
many kilometers/year (not including travel to and
from the workplace)?
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:
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