Auto insurance

Change of annual driving distance

Fill out this secure form to modify the annual driving distance for your vehicle(s).

Important! If this modification applies to three or more vehicles, an agent will contact you.

I want the change to apply to:

First name

Last name

Phone

Policy number

Effective date of the change

Vehicle 1

Year

Make

Model

Annual mileage for the vehicle km

Ex. : 16000

Mileage to work or school (one way only) km

Ex. : 24

Annual mileage for business km

Ex. : 4000

Véhicule 2

Year

Make

Model

New annual distance driven km

Ex. : 16000

New work or school commuting distance (one-way only) km

Enter 0 (zero) if you do not use this vehicle to go to work or school

New annual distance driven for business km

Enter 0 (zero) if you do not use this vehicle for business.

I request that the mileage of the insured vehicle mentioned above be modified, as of the specified date.

I request that the mileage of the insured vehicles mentioned above be modified, as of the specified date.

Message (optional)