Personal Auto Insurance - Delete Vehicle Request

Page Insurance, Ltd

102 Boston Street

Guilford, CT 06437

(203) 453-5258

info@pageins.com
Personal Auto - Vehicle Deletion Form
Effective Date of Change*

MonthDayYear
Who is requesting this change?*
Insured Name*

First NameLast Name
Insured E-mail
Insured Phone No.

Area CodePhone Number
Insurance Company
Policy Number
Vehicle Being Deleted
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle ID #
Reason*
Request Taken By*

George PageAstrid PageSubmitted online by insured
Deletion of a vehicle / cancellation is reported to the Commissioner of motor vehicles by all insurance companies. If you do not immediately return your registration marker plates you may receive one or more written inquiries from the DMV concerning whether or not the required minimum insurance has been maintained. You must respond to these inquiries.

If your insurance coverage lapses, the commissioner may suspend the registration(s) for the vehicle(s) covered under the policy. Your registration marker plates will be subject to confiscation. If you continue to operate the vehicle after the registration has been suspended you will be subject to penalties for operating motor vehicle with suspended registration
Confirmation*

I have read and understand the above statement. This is to confirm / acknowledge the above-mentioned change to the policy.
Insured Name
Signature Of Named Insured
Today's Date

MonthDayYear
Special Notes:
Should be Empty:

Personal Auto - Vehicle Deletion Form