This form will allow you to change the reference of an existing driver on an existing vehicle covered by your policy. This form covers vehicles used mainly for personal purposes.
For instance, you were an occasional driver on vehicle 1 and you are now the principal driver. The person who was principal driver is now the occasional driver.
This form is mainly for personal use vehicles.
It is important to describe the situation of each driver affected by the change.
For your added protection, any change you make to your policy does 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.
Name(s) of insured(s) (as named on your policy)
1st Named Insured:
2nd Named Insured:
Your preferred means of communication for contact and follow-up :
E-mail
Phone
We can only accept changes from policyholders. Please check this authorization box, before completing the rest of the form :
I'm the owner of the policy and I'm authorized to submit these changes.
Disclaimer
E-mail address :
Daytime telephone number :
Area 204 250 289 306 403 416 418 450 506 514 519 604 613 647 705 709 780 807 819 867 902 905 ext :
Home telephone number :
Area 204 250 289 306 403 416 418 450 506 514 519 604 613 647 705 709 780 807 819 867 902 905
Name of driver 1 :
Date of birth :
(dd / mm / yyyy)
This driver now operates the following vehicle(s) :
Vehicle
Make
Year
Model
Type of driver
1
Select Principal Occasional
2
3
Name of driver 2 :
Name of driver 3 :
When will this change be effective ?
Specify the policy to which this change applies:
Company
If other, specify
Insurance policy number
Select Intact Insurance ING Novex ING Western Union Other
Is there any other information you want to send us ?
