Change Use of Vehicle

Insurance coverage cannot be bound or amended via submission of any online form/application provided on this site or otherwise, e-mail, voice mail or facsimile. No change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly by a licensed broker. Any change of insurance we may present to you will be based upon the information you provide to us via this online form/application and/or in other communications with us. Please contact our office at 705-742-3461 to discuss.

Name(s) of insured(s)
Vehicle Information
Is this vehicle used out of the province more than 30 days/year:
Is this vehicle used for commercial or delivery purposes:
Effective Date
When will this date be effective:
About Your Insurance (Specify the policy to which this change applies)