Change Driver Details Form

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.

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   

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

Select Principal Occasional

     3

Select Principal Occasional

Name of driver 2 :

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

Select Principal Occasional

     3

Select Principal Occasional

Name of driver 3 :

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

Select Principal Occasional

     3

Select Principal Occasional

When will this change be effective ?   

Company

If other, specify

Insurance policy number

Select Intact Insurance ING Novex ING Western Union Other