Replace a Vehicle
About You
Name(s) of insured(s):
1
st
insured:
2
nd
insured:
How can we reach you?
E-Mail
Phone
E-mail address:
Daytime telephone #:
Home telephone #:
Fax #:
Prior Vehicle
Vehicle make:
Year:
Model:
New Vehicle
Vehicle make:
Year:
Model:
Condition at time of purchase:
New
Demo
Used
Purchase date(dd/mm/yy):
Purchase price:
VIN (vehicle ID #):
Any non-factory modifications to the vehicle?
Yes
No
Any unrepaired damage?
Yes
No
If yes, specify:
Is vehicle leased or financed?
Yes
No
If yes, specify whether leased or financed:
Leased
Financed
Names and address of leasing company lien holder:
Use of vehicle:
Pleasure
Commuting
Business
Farming
Other
Comments (details if use is other):
Kilometres 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
0-9
9-16
17-24
25-34
35-50
50+
Will adding this vehicle result in changes in use of other
vehicles owned?
Yes
No
Driver Information
(for all drivers who will be operating this vehicle)
Driver #1
Driver #2
Driver #3
Driver:
Date of birth (dd/mm/yyyy):
Driver type:
Principal
Occasional
Principal
Occasional
Principal
Occasional
Effective Date
When will this change be effective?
(dd/mm/yyyy):
About Your Insurance
(Specify the policy to which this change applies)
Company:
Policy #:
Additional Comments:
info@ifgcanada.com
1-800-563-7283
