Tools & Resources - Bertram & Barry Insurance Ltd.


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		Policy Change Forms
		– Overview – Address Change – Add a Vehicle – Delete a Vehicle – Replace a Vehicle – Change Use of a Vehicle




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Tools & Resources

Policy Change Forms – Change Use of a Vehicle

About You

Name(s) of insured(s):

1^st insured:

2^nd insured:

How can we reach you?

E-mail address:

Daytime telephone #:

Home telephone #:

Fax #:

Vehicle Information

Vehicle make:

Year:

Model:

Use of vehicle:

Comments (details if use is other):

Is this vehicle used out of the province more than 30 days/year?

Yes

Is this vehicle used for commercial or delivery purposes?

Yes

Kilometres traveled per year:

How many kilometers one-way for daily commute?

If this vehicle is used for work-related travel, how many kilometers/year (not including travel to and from the workplace)?

Effective Date

When will this change be effective? (dd/mm/yyyy)

About Your Insurance
(Specify the policy to which this change applies)

Company:

Policy #:

Will this change in use result in changes in use of any other vehicles owned?

If so, please indicate what will change:

Name of your broker: