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Change Use of Vehicle
Name(s) of insured(s)
1st insured:
2nd insured:
How can we reach you:
E-Mail
Phone
E-mail address:
Daytime telephone #:
Home telephone:
Fax #:
Vehicle Information
Vehicle make:
Year:
Model:
Use of vehicle:
Pleasure
Commuting
Business
Farming
Other
Comments (detials if use is other):
Is this vehicle used out of the province more than 30 days/year:
Yes
No
Is this vehicle used for commercial or delivery purposes:
Yes
No
Kilometers traveled per year:
0-5000
5001-10000
10001-15000
15001-20000
20001-25000
25001-30000
30001-over
How many kilometers one-way for daily commute:
N/A
0-5
6-8
9-16
17-24
25+
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:
Overview
Web Links
Insurance Tips
Glossary Of Terms
Policy Change Forms
Address Change
Replace Vehicle
Add Vehicle
Delete Vehicle
Change Use of Vehicle
Claims
CISRO Principles of Conduct
RIBO Broker Fact Sheet