Hallmark Inc. - Policy Change Forms

Insurance Brokers Ltd. | Financial Planning Ltd. | 416.492.4070

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FAQ’s

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-	Overview
-	Address Change
-	Add a Vehicle
-	Delete a Vehicle
-	Replace a Vehicle
-	Change Use of a Vehicle
-	Changes to Homeowner’s or Tenant’s Policy
-	Submit or Change Payment Information
-	Add/Delete a Driver

Making a Claim

Policy Change Forms — Add Vehicle

About You

Request For:

Name(s) of insured(s):

1^st insured:

2^nd insured:

How can we reach you?

E-mail address:

Daytime telephone #:

Home telephone #:

Fax #:

New Vehicle

Vehicle make:

Year:

Model:

Condition at time of purchase:

Purchase date(dd/mm/yy):

Purchase price:

VIN (vehicle ID #):

Any non-factory modifications to the vehicle?

Yes

Any unrepaired damage?

Yes

If yes, specify:

Is vehicle leased or financed?

Yes

If yes, specify whether leased or financed:

Names and address of leasing company lien holder:

Use of vehicle:

Comments (details if use is other):

Kilometres traveled per year:

How many kilometers one-way for daily commute?

Will adding this vehicle result in changes in use of other
vehicles owned?

Yes

Third party Liability coverage requested:

Collision coverage and deductible requested:

No Coverage
Yes - deductible
(min) $500	$1000	Higher

Comprehensive coverage and deductible requested:

No Coverage
Yes - deductible
(min) $300	$500	Higher

All perils coverage and deductible requested:

No Coverage
Yes - deductible
(min) $500	$1000	Higher

Driver Information

(for all drivers who will be operating this vehicle)

Driver #1

Driver #2

Driver #3

Driver:

Date of birth (dd/mm/yyyy):

Driver type:

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:

Disclaimer

Liability Statement

Members