Brokers & Agents - Forms

Underwriting Forms

• Facility Association Common Management Attestation

• Application by Broker for Appointment to a Servicing Carrier

• Commercial Vehicle Supplement

• Explosives Questionnaire

• Fleet Rating Information Statement

• TORT Fleet Schedule

• DCPD Fleet Schedule

• Indemnification and Hold Harmless Agreement

• Radioisotope Questionnaire

• Taxi/Limousine Questionnaire

• Motorcycle Inspection Form

• Winter Tire Declaration Form

• Verification of Automobile Insurance for Leasing Companies or Lienholders

Endorsement Forms

• FA 82 Deductible Amount Endorsement

Other endorsement forms and application forms can be found here.

Underwriting Forms

• Garage Rating Underwriting Supplement

Endorsement Forms

• 8A English Property Damage Reimbursement for Operation by Named Person Endorsement (Section A Only) (for use in the Atlantic Provinces)

• 9 English Marine Use Excluded Endorsement (amphibious automobiles)

• 9 Français Exclusion du Risque Maritime (automobiles amphibies)

• 13c English Comprehensive Cover – Deletion of Glass Endorsement

• 13c Français Suppression de la Garantie de la Division 3 du Chapitre C en ce qui Concerne les Glaces

• 16 English Agreement for Suspension of Coverage Endorsement

• 16 Français Suspension de Garanties pour Remisage

• 19 English Limitation of Amount Endorsement

• 19 Français Limitation Visant le Chapitre C

• 28 English Reduction of Coverage as Respects Operation by Named Person(s) Endorsement

• 28 Français Restriction de la Garantie - Conducteurs Désignés

• 30 English Excluding Operation of Attached Machinery Endorsement

• 30 Français Restriction Visant l'Équipement et/ou le Matériel

• 37 English Limitation to Automobile Sound and Electronic Communication Equipment Endorsement (for use in the Atlantic Provinces)

• 37 Français Limite - Accessoires de Son et de Communication Électronique

• 40 English Fire and Theft Deductible Endorsement

• 40 Français Franchise en Cas d'Incendie ou de Vol

Underwriting Forms

• Garage Rating Underwriting Supplement

• English Binder Control Register

• French Binder Control Register

Endorsement Forms

• 9 Marine Use Excluded Endorsement (amphibious automobiles)

• 13c Comprehensive Cover – Deletion of Glass Endorsement

• 16 Agreement for Suspension of Coverage Endorsement

• 19 Limitation of Amount Endorsement

• 28a Excluded Driver Endorsement (Newfoundland and Labrador Only)

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment Endorsement (for use in the provinces of NL)

• 38 Increased Limit, Automobile Sound and Electronic Communication Equipment Endorsement (for use in the provinces of NL)

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Automobile Insurance – Facility Association Reporting Forms (Public Utilities Board Website)

• PUB Monthly Electronic FA Submission 125 (.xlsx)

• PUB Monthly Electronic FA Submission 750 (.xlsx)

• Garage Rating Underwriting Supplement

Endorsement Forms

• 8a Property Damage Reimbursement for Operation by Named Person Endorsement (Section A Only)

• 9 Marine Use Excluded Endorsement (amphibious vehicles)

• 13d Comprehensive Cover - Limited Glass (for Alta., Nunavut, N.W.T. and Yukon)

• 16 Agreement for Suspension of Coverage Endorsement

• 19 Limition of Amount Endorsement

• 28 Reduction of Coverage as Respects Operation by Named Person(s) Endorsement

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Garage Rating Underwriting Supplement

Endorsement Forms

• 9 Marine Use Excluded Endorsement (amphibious automobiles)

• 13c Comprehensive Cover – Deletion of Glass Endorsement

• 16 For use in Nova Scotia only - Agreement for Suspension of Coverage Endorsement

• 19 Limition of Amount Endorsement

• 28a Excluded Driver (Nova Scotia only)

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment Endorsement

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Garage Rating Underwriting Supplement

• Binder Control Register

Endorsement Forms

• 8a Property Damage Reimbursement for Operation by Named Person Endorsement (Section A Only)

• 9 Marine Use Excluded Endorsement (amphibious vehicles)

• 13d Comprehensive Cover - Limited Glass (for Alta., Nunavut, N.W.T. and Yukon)

• 16 Agreement for Suspension of Coverage Endorsement

• 19 Limition of Amount Endorsement

• 28 Reduction of Coverage as Respects Operation by Named Person(s) Endorsement

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Garage Rating Underwriting Supplement

Endorsement Forms

• FA 82 Deductible Amount Endorsement

• OCPF 19 Limiting the Amount Paid for Loss or Damage Coverages

• Automobile Insurance Policy (O.A.P.1), Garage Automobile Policy (O.A.P 4), Application and Endorsement Forms

Underwriting Forms

• Garage Rating Underwriting Supplement

• Refusal Letter

Endorsement Forms

• 9 Marine Use Excluded Endorsement (amphibious automobiles)

• 13 Comprehensive Cover – Deletion of Glass Endorsement

• 16 Agreement for Suspension of Coverage Endorsement

• 19 Limition of Amount Endorsement

• 28A Excluded Driver Endorsement

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment Endorsement (for use in the Atlantic Provinces)

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Garage Rating Underwriting Supplement

Endorsement Forms

• 8a Property Damage Reimbursement for Operation by Named Person Endorsement (Section A Only)

• 9 Marine Use Excluded Endorsement (amphibious vehicles)

• 13d Comprehensive Cover - Limited Glass (for Alta., Nunavut, N.W.T. and Yukon)

• 16 Agreement for Suspension of Coverage Endorsement

• 19 Limition of Amount Endorsement

• 28 Reduction of Coverage as Respects Operation by Named Person(s) Endorsement

• 30 Excluding Operation of Attached Machinery Endorsement

• 37 Limitation to Automobile Sound and Electronic Communication Equipment

• 40 Fire and Theft Deductible Endorsement

Underwriting Forms

• Garage Rating Underwriting Supplement