Change Vehicle Use Form

 This form will allow you to specifically change the usage of your personal use vehicle.

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   

The vehicle use is now :

 Make :

 Year :

 Model :

 Use :  

Select Pleasure (no commuting) Commuting to work or school Business Farming Commercial Other

 If other use, specify :

Is this vehicle used outside of province more than 30 days a year ?

YesNo

Is this vehicle used for commercial or delivery purposes ?

YesNo

How many kilometres a year does this vehicle travel ?

Select 0 to 5 000 5 001 to 10 000 10 001 to 15 000 15 001 to 20 000 20 001 to 25 000 25 001 to 30 000 30 001 and more

How many kilometres (one way) is this vehicle driven daily to go to work or school ?

Select 0 less than 9 9 to 16 17 to 24 25 to 34 35 to 50 more than 50      

If this vehicle is used for work-related travel, indicate how many kilometres are driven annually, not including the distance to the workplace.

When will this change be effective ?   

Company

If other, specify

Insurance policy number

Select Intact Insurance ING Novex ING Western Union Other