Insurance Auto For Tcm

Underwriting Information for Automobile Insurance 料資保投險保車汔料資保投險保車汔料資保投險保車汔料資保投險保車汔 Name of Applicant / Insured: ：名姓人保投 __________________________________________________________________________________________________________________ Full Address (with postal code): ：碼號區郵及址地 ____________________________________________________________________________________________________________ Insurance Company of most recent automobile insurance: ）稱名紀經是不：意注請（稱名司公險保之保投時現 ___________________________________________________________ Policy Number: ______________________ ：日期到單保 Expiry Date: 碼號單保 ______________ Existing Policy Liability Limit: (e.g. $1,000,000): ）額金他其或萬百一幣加（額險保三第之單保現 e.g. : __________________________________________________________________ Existing Policy Physical Damage Deductible: (e.g. Comp $500, Coll & upset $1,000; OR All perils $1,000): ：）費底墊稱或（額負自之單保現 __________________________________ Number of automobiles in the household or business: ：目數車汔之障保單保現 ___________________________________________________________________________________ How long has the principal driver/registered owner has auto insurance: ：險保車汔買購始開國加在時何於下閣 __________________ years 料資輛車他其上填格表一另用請，部兩過超如，料資車汔之保投所下閣出列表下於請料資輛車他其上填格表一另用請，部兩過超如，料資車汔之保投所下閣出列表下於請料資輛車他其上填格表一另用請，部兩過超如，料資車汔之保投所下閣出列表下於請料資輛車他其上填格表一另用請，部兩過超如，料資車汔之保投所下閣出列表下於請料資他其料資他其料資他其料資他其 Auto 司公務財之賃租期長 Vehicle Information 稱名商產生及份年車汔 Owned / Leased and date of 途用之輛車部每者駛駕資車部每 No. YEAR/MAKE/MODEL No. (Serial No.) purchased/leased Lessor (if applicable) Use of vehicle Drivers Example 稱名商產生及份年車汔碼號擎引車汔 Owned賃租 ____ Leased 購自 ______ Name 稱名 : Pleasure 閒消物購____________ Principal Driver: 2009 TOYOTA CAMRY 4-DR JF1AB12344D567890 Date purchased 期日買購 : Feb. 25, 2009 Business ( 等談洽意生業商 ) ____________ ：者輛車此駛駕要主 Body Type : Sedan New車手二 __X __車新 Used _____ Address址地 : Commercial 貨送____________ Secondary Driver: No. of Cylinders/Engine Size: 4 Registered owner other than Commute - one way 數里程單之點地作工返往 10 _ km ：者駛駕位二第 Applicant 車出列請，人保投非主車冊註如 Estimated Annual Mileage Occasional Driver: : __________________________ 稱名主 : e.g. 20,000 km 數里車行之計估年每：者駛駕性歇間 1 稱名商產生及份年車汔碼號擎引車汔 Owned 賃租 ______ Leased 購自 ______ Name 稱名 : Pleasure ____________ 閒消物購 Principal Driver: Date purchased 期日買購 : ____________ Business ( ) ____________ 等談洽意生業商：者輛車此駛駕要主 Body Type 號型 : New車手二 __X __車新 Used _____ Address址地 : Commercial ____________ 貨送 Secondary Driver: No. of Cylinders/Engine Size Registered owner other than Commute - one way 數里程單之點地作工返往 km ：者駛駕位二第 ( ) 料資缸汽擎引 : Applicant 車出列請，人保投非主車冊註如 Estimated Annual Mileage 車行之計估年每 Occasional Driver: : ___________________________ 稱名主數里 : ___________________________ ：者駛駕性歇間 2 稱名商產生及份年車汔碼號擎引車汔 Owned 賃租 ______ Leased 購自 ______ Name 稱名 : Pleasure ____________ 閒消物購 Principal Driver: Date purchased 期日買購 : ____________ Business ( ) ____________ 等談洽意生業商：者輛車此駛駕要主 Body Type 號型 : New車手二 __X __車新 Used _____ Address址地 : Commercial ____________ 貨送 Secondary Driver: No. of Cylinders/Engine Size Registered owner other than Commute - one way 數里程單之點地作工返往 km ：者駛駕位二第 ( ) 料資缸汽擎引 : Applicant 車出列請，人保投非主車冊註如 Estimated Annual Mileage 車行之計估年每 Occasional Driver: : ___________________________ 稱名主數里 : ___________________________ ：者駛駕性歇間 Driver Information: List all drivers of the described automobile(s) in the household or business 者照執駛駕有持中居家下閣在括包，料資者駛駕有所報申格表列下於請者照執駛駕有持中居家下閣在括包，料資者駛駕有所報申格表列下於請者照執駛駕有持中居家下閣在括包，料資者駛駕有所報申格表列下於請者照執駛駕有持中居家下閣在括包，料資者駛駕有所報申格表列下於請期日照執取領國加在 G2 Driver 字名者駛駕字名者駛駕字名者駛駕字名者駛駕碼號照執駛駕碼號照執駛駕碼號照執駛駕碼號照執駛駕期日照執取領國加在 G Date when first obtained G2 書證班駛駕有持否是書證班駛駕有持否是書證班駛駕有持否是書證班駛駕有持否是況狀姻婚況狀姻婚況狀姻婚況狀姻婚 No. Driver Name Driver Licence No. Date 1st licensed in Canada - Class G Lic. Driver Training Certificate Marital Status 1 Yes 是 ____ No 否 _____ Single 身單 Married 婚已 Others 他其 2 Yes 是 ____ No 否 _____ Single 身單 Married 婚已 Others 他其 3 Yes 是 ____ No 否 _____ Single 身單 Married 婚已 Others 他其 4 Yes 是 ____ No 否 _____ Single 身單 Married 婚已 Others 他其 5 Yes 是 ____ No 否 _____ Single 身單 Married 婚已 Others 他其 Are any other persons I the household or business licensed to drive 仕人照執駛駕有持他其有否是司公或居家下閣在，外者駛駕述上除 ? Yes 是 _____ No _____ 否 Claims History - any claim or loss in the past 6 years. If so, provide date, details of claim/loss, vehicle/driver & who is responsible for the claim e.g. 100% at fault or 100% NOT at fault, or partially at fault etc. 。等失過犯所者駛駕保投屬否是，料資故事，日、月、年外意出列請，錄記償索之內年六去過在。錄記償賠 Convictions - any conviction e.g. speeding. If so, provide date, description of the conviction and the driver responsible 。外除車泊例違駛駕酒醉速超如，料資票告之到收曾者駛駕位每出列請 , ( ) Any Other comments and/or Information 等裝改否曾如，料資之輛車保投所內單保此關有他其出列請 : Please add a supplementary page if needed. 。內頁加附於寫填料資將可，要需有如 S:0 ClientsTCM Personal Line Program2009-10Form - ApplicationInfo Auto Insurance Chinese.xls

Insurance Auto For Tcm

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