Policy Change

Insured Name*
Policy Number or Binder Number*
Policy Change Effective Date*
Date Format: DD slash MM slash YYYY

Cannot be backdated - Format - dd/mm/yyyy
Policy Change Type*
- Vehicle Addition / Deletion
- Driver Addition / Deletion
- Property Addition / Deletion
- Equipment Addition / Deletion
- Something Else to be Changed
Please select all types of applicable changes for this policy only. Do not enter changes for different policies on same policy change request. Please create a separate request for each policy.
Vehicle Addition/ Deletion

Example:- Delete/ Add - Year, Make, Model and VIN, Purchase or Sale Date | Delete - 2018 Hino 386 1 HSG7856785GBHG986 April 20, 2019
Driver Addition/ Deletion

Example:- Delete/ Add - Name, Date of Birth, License Number | Add Tom Gates 28 Oct 1986 DL# - 166543- 982
Property Addition/ Deletion

Example:- Address - 4112 30 St NW, Edmonton, AB, T6T 1K5, Value - Building - $ 500K and Content $300K, Year Built - 1999, Type of Fire Protection - Fire Hydrants and Extinguishers
Equipment Addition/ Deletion

Example:- Year - 2004, Make - BOB CAT, Model - 65R, Serial Number - 654FG32 Value - $ 58000
Describe the policy change you need
Please include as much information as you can and attach relevant documents later.
Name of Person Requesting Policy Change*
First Last
Email
Phone
Upload all the documents related to this policy change
Drop files here or
Example : Bill of Sale, Drivers Abstract, Registration, Old Pink Card etc.
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