Add/Delete Vehicle Form - CMR Insurance

To add or delete a vehicle please complete the information below. Please be advised that only a named insured can request changes to a policy. Please also note that coverage can not be changed or bound without speaking directly to a licensed insurance broker. As such, a CMR Broker will contact you to confirm if and when your change request has been completed.
Full name
Policy Number
Email
Phone
Vehicles
- Add Vehicle
- Remove Vehicle
Date to Remove Vehicle
MM slash DD slash YYYY
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle VIN
Vehicle Year
Purchase Date
MM slash DD slash YYYY
Ownership
- New
- Used
- Leased
- Financed
Lessor name & address (if applicable)
Lienholder name & address (if applicable)
Full Name of principle driver of this vehicle
Annual km Driven
Commute distance one way
Date you want vehicle added to your policy
MM slash DD slash YYYY
Are you also deleting a vehicle from your policy
- Yes
- No
Vehicle year, make and model
Date you want vehicle deleted from your policy
MM slash DD slash YYYY
Date vehicle to be deleted from policy
MM slash DD slash YYYY
Comments