Millennium Policy Address Change Request Form

Address Change Request
Your Name*
Your Policy Number*
Email on Policy*
Phone Number on Policy*
Please enter a valid phone number.
Best Contact Phone Number*
Please enter a valid phone number.
Please select change details:*
When will this change take effect?*

MonthDayYear
Date

Change of Address
What is your new mailing address?*
Is your new mailing address the same as your new physical address?*

YesNo
Physical Address
How will the vehicle be used now that you have moved? (Please check all that apply)*

Commuting (eg. To Work or School)Pleasure (eg. Work from Home, Retired)Business (eg. Realtor, Consultant, Tradesperson, Uber)
Additional Details
How many kilometers is it one way from your new residence to work or school?
Now that you have moved, how many kilometers will you drive annually?*
How many of your annual kilometers will be used for business?
Are there any other licensed drivers living in your new home that are not already on your policy?*

YesNo
Other licensed driver details (name, relationship):
Do they have their own vehicle and insurance?*

YesNo
*Please note: As you require an address change on your property policy, a service agent will contact you at {bestContact} to verify information before processing your request.
Disclaimer:

Millennium Insurance Corporation ("Millennium") reserves the right to verify this information. This information is not a declarations page, policy, endorsement or otherwise intended to form part of your contract of insurance. Always refer to your insurance policy for information about your coverage, including limits, deductibles, and exclusions. In case of discrepancy, the insurance contract prevails over general information available on this site. Any policy related changes made on this site will not be effective until you receive confirmation. If you have any questions or require further information, contact us. Find out how we protect your personal information in our Privacy Policy.
Should be Empty:

Address Change Request

*Please note: As you require an address change on your property policy, a service agent will contact you at {bestContact} to verify information before processing your request.