Driver Deletion Form

This form will allow you to remove a driver on your policy.
When you remove a driver, he/she is removed from all of the vehicles on the policy.

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.

About you

Name(s) of insured(s)
(as named on your policy)   

1^st Named Insured:

2^nd 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   

Please remove the following driver from my policy :

Name of Driver :

Date of birth :   

 (dd / mm / yyyy)

Will this deletion of driver result in changes to the way the
vehicle is operated by the remaining driver(s) on the policy ?

 YesNo

When will this change be effective ?   

(dd / mm / yyyy)

Company

If other, specify

Insurance policy number

Select Intact Insurance ING Novex ING Western Union Other