Add a Driver - HIFA Insurance Brokers

Add a driver

Add a Driver

Date

Full name

Phone

Policy#

Effective date:

Full name:

Date of birth:

Street address

Unit#, etc.

City

Province

Postal code

Date received G1:

Date received G2:

Date received G:

Completed MTO driver's training?

Yes

MTO driver's training certificate#

Are you a student?

Yes

Residing at home or at campus

Home

Campus

If student living at campus, proof must be provided:

Relationship to the insured

Date first insured in canada

Date started insurance with current co.

# of minor convictions/tickets in last 3 years

# of major convictions in last 6 years

# of accidents at fault in last 8 years

# of accidents not at fault in last 8 years

# of claims in last 6 years

Pay out for claim (use + sign to enter the amount for each claim)

Amount

Any additional relevant information you would like to share?

Finding exactly the right insurance coverage is not a daunting process at HIFA. We’ll make it straightforward and hassle-free so you’ll know exactly what you’re getting and can feel confident that you have the right coverage.