Insurance Driver Policy

INSURANCE DRIVER POLICY

Policy Identification

Policy Period: From to Effective time:

Insured / Applicant Information

Named Drivers

List all persons who are regular drivers of insured vehicles. Provide full legal name, relationship, date of birth, and driver's license number.

Insured Vehicles

List each covered vehicle. Attach separate schedule if more space is required.

Coverages & Limits

Select coverages to be provided under this policy and specify limits or deductibles where applicable. If a coverage is selected but a limit is left blank, the insurer's standard minimum will apply as set out in policy provisions.

Premium, Fees & Payment

Exclusions & Conditions

The coverages provided by this policy are subject to exclusions, conditions, endorsements and limits contained in the policy document. The insurer shall not be liable for loss or damage:

• Resulting from intentionally caused damage or willful misconduct by an insured;
• Arising while the insured vehicle is used in the commission of a felony or while operating under the influence of alcohol or drugs;
• For vehicles used as public or livery conveyances unless specifically endorsed;
• For loss resulting from failure to maintain the vehicle in a safe, roadworthy condition when such failure materially contributed to the loss.

Beneficiary / Payee Designation

Designate the beneficiary or payee for death benefits or other payable sums where applicable under Personal Injury Protection or similar coverages.

Policy Conditions, Duties & Notices

Material misrepresentation, omission of material facts, or failure to cooperate with the insurer in the investigation or defense of a claim may result in denial of coverage, cancellation, or rescission of this policy from inception. The insured must:

1. Report any accident or loss to the insurer or its authorized representative promptly and in the manner required by the policy;
2. Cooperate fully in the investigation and settlement of any claim and provide all requested documentation; and
3. Notify the insurer of any change in primary garaging location, additional regular drivers, or change of ownership of a covered vehicle.

Cancellation by the insured shall be effective upon receipt of written notice to the insurer. Cancellation by the insurer shall be effective in accordance with the policy provisions and applicable law. Premium adjustments, if any, will be made in accordance with the insurer's premiums and policy terms.

Subrogation: Where the insurer pays a claim, the insurer shall be subrogated to the rights of the insured against any third party responsible for the loss, and the insured shall execute all papers and do whatever else is necessary to secure such rights.

Endorsements & Remarks

Applicant Certification

I certify that the information provided in this Insurance Driver Policy application is true and complete to the best of my knowledge. I understand that any material misrepresentation or omission may result in denial of coverage or rescission of the policy. I authorize the insurer to obtain and verify underwriting information, including driving records and loss history, and I agree to provide further documentation upon request.

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