Tools & ResourcesChange Use of Vehicle

Name(s) of insured(s)
1st insured:
2nd insured:
How can we reach you:
E-mail address:
Daytime telephone #:
Home telephone:
Fax #:
Vehicle Information
Vehicle make:
Year:
Model:
Use of vehicle:
Comments (detials if use is other):
Is this vehicle used out of the province more than 30 days/year:	YesNo
Is this vehicle used for commercial or delivery purposes:	YesNo
Kilometers 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 date be effective:	Date and time
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:

Disclaimer

Only the person named as the insured in the policy documents can make changes to the policy. By submitting this form, you acknowledge that you are the policyholder and are authorized to make changes to your information.

Please be advised that coverage cannot be bound nor can any additions or deletions to coverage be made by leaving a voice mail message, email message or by submitting this form. Coverage is only confirmed once you have spoken directly with a licenced insurance broker and/or you are in receipt of written confirmation.

If you have not received an acknowledgement within two business days, please contact our office and speak directly to one of our licensed insurance brokers. Sheehan & Rosie Ltd. is not responsible for instructions not received. All policy terms and conditions apply, subject to policy status at time of submission.

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