Policy Checkup: Auto

Driver Details

List of drivers on policy:

Are there any other people in the household with a driver license that are not already listed above?*

Yes
No

Please note that all drivers living in the household must be disclosed, regardless of whether they have access to your vehicle or not.

Please provide the following Information for the unlisted drivers: name, date of birth, occupation, and what vehicle they are currently driving.*

How many vehicles are there on this policy?*

Vehicle 1

Please type in the year, make model of vehicle #1 on your policy:*

Veh 1: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 1: Please indicate any coverage changes you would like make to this vehicle (ex: increase liability limit, delete collision coverage, etc.).*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 1: Who is the primary operator of this vehicle?*

Veh 1: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 1: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 1: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 1: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 1: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 1: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 1: Please provide details of the potential business/commercial use for this vehicle:*

Vehicle 2

Please type in the year, make model of vehicle #2 on your policy:*

Veh 2: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 2: Please indicate the coverage changes you would like to make to this vehicle (ex: increase liability limit, delete collision coverage, etc.):*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 2: Who is the primary operator of this vehicle?*

Veh 2: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 2: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 2: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 2: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 2: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 2: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 2: Please provide details of the potential business/commercial use for this vehicle:*

Vehicle 3

Please type in the year, make model of vehicle #3 on your policy:*

Veh 3: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 3: Please indicate the coverage changes you would like to make to this vehicle (ex: increase liability limit, delete collision coverage, etc.):*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 3: Who is the primary operator of this vehicle?*

Veh 3: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 3: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 3: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 3: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 3: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 3: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 3: Please provide details of the potential business/commercial use for this vehicle:*

Vehicle 4

Please type in the year, make model of vehicle #4 on your policy:*

Veh 4: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 4: Please indicate the coverage changes you would like to make to this vehicle (ex: increase liability limit, delete collision coverage, etc.):*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 4: Who is the primary operator of this vehicle?*

Veh 4: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 4: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 4: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 4: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 4: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 4: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 4: Please provide details of the potential business/commercial use for this vehicle:*

Vehicle 5

Please type in the year, make model of vehicle #5 on your policy:*

Veh 5: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 5: Please indicate the coverage changes you would like to make to this vehicle (ex: increase liability limit, delete collision coverage, etc.):*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 5: Who is the primary operator of this vehicle?*

Veh 5: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 5: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 5: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 5: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 5: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 5: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 5: Please provide details of the potential business/commercial use for this vehicle:*

Vehicle 6

Please type in the year, make model of vehicle #6 on your policy:*

Veh 6: Would you like to make any changes to the existing coverages on the policy for this vehicle?*

Yes, make changes
No, keep all coverages the same

Veh 6: Please indicate the coverage changes you would like to make to this vehicle (ex: increase liability limit, delete collision coverage, etc.):*

Please note that no changes will take effect until a broker has reviewed and called to finalize the change.

Veh 6: Who is the primary operator of this vehicle?*

Veh 6: If there are any occasional operators of this vehicle that are NOT listed as primary operators on another vehicle on this policy, list them here:

Veh 6: Does any driver of this vehicle have any traffic convictions (pull-over only) within the past 3 years, OR at-fault claims within the past 6 years?*

Yes
No

Veh 6: Please provide dates and details of those tickets within the past 3 years and claims within the past 6 years for the drivers of this vehicle (if you're unsure of date, just make your best guess):*

Veh 6: One-way commute: How many kms is the vehicle driven to go to work or school?*

Veh 6: Estimated total annual kms for this vehicle (average is between 15,000 to 25,000 for most working adults):*

Veh 6: Is there any business or commercial use for this vehicle whatsoever - such as driving for hire, carrying tools or materials for a trade, transporting goods or passengers for hire, etc.*

Yes, some business or commercial use
No business or commercial use whatsoever

Veh 6: Please provide details of the potential business/commercial use for this vehicle:*

Driver Details

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Combined discount and additional coverages

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