Commercial Auto Vivek

How Often Hauling is Done for Others?*

Daily
Weekly
Monthly
Never

What type of material is carried?*

Example:- Lumber - 50%, Steel - 25%, Livestock - 25%

Explosive, volatile, toxic, corrosive or radioactive material?*

Yes
No

Please upload the product detail document if answer is yes.

Is vehicle Rented to others?*

Yes
No

Distance of Usual Trip in KM*

Please enter a number from 0 to 5000.

Example :- Put 250 if usual round trip is 250 Km

No. of Trips per Month above 40 Kms*

Please enter a number from 0 to 500.

Furthest distance in KM*

Please enter a number from 0 to 5000.

Describe the Route*

Examples : Within Calgary; All Around Alberta; Only Alberta and Northern BC; All Across Canada etc.

Describe any machinery or equipment mounted on or attached to vehicles and other modification(s) and unrepaired damage(s).

Driving License Numbers of all Drivers in separate boxes*

Please click on plus button to add more boxes.

Year, Make, Model and VIN Numbers of all Vehicles in separate boxes*

Example :- 2010 Hino 386 1KH5437HD6743CV89

Limit of Insurance required in Separate Boxes

Limit 1	Limit 2	Limit 3

Example :- Liability - $ 2 Million, Cargo - $250K, Auto Physical Damage - $2500 Deductible. Leave it blank if you are not aware what you need.

Claims Details in Last Six Year with Month, Year

Example :- Jan 2017 - Collision with Another Automobile. Please enter None if not applicable

Convictions/ Tickets Details in Last Three Year with Month, Year

Example :- Jan 2017 - Speeding Ticket

Name of your Company and your Name*

This is the name of company or individual to whom policy will be issued.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Upload Documents

Drop files here or

Max. file size: 10 MB, Max. files: 25.

Example :- You may upload Pink Card, Drivers Abstract, Certificate of Insurance, Experience Certificate, Driver List, Automobile List etc.

Consent*

I allow you to extract my past driving data.

By providing your driver's license you are hereby authorizing us to retrieve your prior insurance information, including those of any previously listed drivers from whom I have obtained consent, in order to provide you with faster and more accurate quote.

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