This form will allow you to remove a vehicle on your policy. It is mainly for personal use vehicles.
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 :
Vehicle make :
If you have more than one vehicle, will the deletion of this vehicle
result in changes to the way the remaining vehicle(s) are used ?
When will this change be effective ?
(dd / mm / yyyy)
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 ?