This form will allow you to change the reference of an existing driver on an existing vehicle covered by your policy. This form covers vehicles used mainly for personal purposes.
For instance, you were an occasional driver on vehicle 1 and you are now the principal driver. The person who was principal driver is now the occasional driver.
This form is mainly for personal use vehicles.
It is important to describe the situation of each driver affected by the change.
For your added protection, any change you make to your policy does not become effective until we contact you to verify the change and effective date. This is to protect your existing coverage, should additional information or coverage be required to make the change you have asked.
Name(s) of insured(s)
(as named on your policy)
1st Named Insured:
2nd Named Insured:
Your preferred means of communication for contact and follow-up :
We can only accept changes from policyholders.
Please check this authorization box, before completing the rest of the form :
I'm the owner of the policy and I'm authorized to submit these changes
E-mail address :
Daytime telephone number :
Home telephone number :
Name of driver 1 :
Date of birth :
(dd / mm / yyyy)
This driver now operates the following vehicle(s) :
Type of driver
Name of driver 2 :
Name of driver 3 :
When will this change be effective ?
Specify the policy to which this change applies:
If other, specify
Insurance policy number
ING Western Union
Is there any other information you want to send us ?