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Name(s) of insured(s)
New Vehicle
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Any non-factory modifications to the vehicle:
Any unrepaired damage:
Is vehicle leased or financed:
If yes, specify whether leased or financed:
Will adding this vehicle result in changes in use of other:
Collision coverage and deductible requested:
Comprehensive coverage and deductible requested:
All perils coverage and deductible requested:
Driver #1
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Driver #2
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Driver #3
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Effective Date
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About Your Insurance (Specify the policy to which this change applies)

Disclaimer

Only the person named as the insured in the policy documents can make changes to the policy. By submitting this form, you acknowledge that you are the policyholder and are authorized to make changes to your information.

Please be advised that coverage cannot be bound nor can any additions or deletions to coverage be made by leaving a voice mail message, email message or by submitting this form. Coverage is only confirmed once you have spoken directly with a licensed insurance broker.

If you have not received an acknowledgement within one business day, please contact our office and speak directly to one of our licensed insurance brokers. Mink Insurance Services Ltd. is not responsible for instructions not received. All policy terms and conditions apply, subject to policy status at time of submission.

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Did You Know

IMPORTANT CHANGES TO YOUR AUTOMOBILE POLICY!

Effective June 1, 2016, the Ontario government has introduced changes to the automobile insurance system to help make insurance premiums more affordable.  These changes only apply to auto insurance policies issued or renewed on or after June 1, 2016.
The changes will give you more choice over the coverages you select and the price you pay for auto insurance.  Many of the changes affect the Statutory Accident Benefits you receive if you are injured in an auto accident, regardless of who is at fault.  Some of these benefits have been reduced and some options for increased coverage have been eliminated or changed.
CONTACT US TODAY TO REVIEW YOUR POLICY COVERAGES.

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