AMV

Annual Mileage Verification

This form is programmed to calculate the Annual Mileage so it can be used for annual miles to be rated on an Auto Policy.
Date*

MonthDayYear
Producer Names*
Client Name:*
Last Name, First Name
Policy Number:*
Year - Make*
Last 4 of VIN*
1st Odometer Date*

MonthDayYear
1st Odometer Reading*
2nd Odometer Date*

MonthDayYear
2nd Odometer Reading*
Difference In Days*
Difference in Odometer*
Average Miles (per day)
Annual Miles Calculated
Current Annual Miles that is
Rated on the Policy
Difference in Miles
Should be Empty: