Staebler Insurance Brokers - Tools & Resources

The Best Insurance Is An Insurance Broker

Policy Change Forms - Delete Vehicle

About You

Name(s) of insured(s):

1^st insured:

2^nd insured:

How can we reach you?

E-mail address:

Daytime telephone #:

Home telephone #:

Fax #:

Vehicle Information

Vehicle make:

Year:

Model:

If you have more than one vehicle, will the deletion of this vehicle result in changes to the way the remaining vehicles are used?

Yes

Effective Date

When will this change be effective?
(dd/mm/yyyy)

About Your Insurance
(Specify the policy to which this change applies)

Company:

Policy #:

Reason for deletion the vehicle:

Additional Comments:

Name of your broker:

Disclaimer:

H.L. Staebler Company Limited is not responsible for instructions not received and acknowledged by a confirmation via e-mail or phone call. By submitting this form, you acknowledge that you are the policyholder and the events described on this form are truthful. Only the person named as the insured in the policy documents can submit a claim report on this policy. All policy terms and conditions apply, subject to policy status at time of submission.