Vehicle Insurance Information Form

Vehicle Insurance Information Form
Applicant's Name

First NameMiddle NameLast Name
I own a car:
Name of Insurance Company:
I own a motorcycle:
Name of Insurance Company:
I drive a vehicle registered under another name:
Name of Insurance Company:
Please attach copies of: Driver's license, Vehicle Registration, and Insurance Proof

Cancelof
ALL SEMINARIANS IN THE DIOCESE OF SAN BERNARDINO WHO DRIVE PRIVATE VEHICLES ARE REQUIRED TO CARRY INSURANCE COVERAGE
I swear under penalty of perjury the above to be true and correct
Signature
Date

MonthDayYear
Should be Empty: