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Trucking Insurance
Company Information
Company Name:
Contact Person:
Address:
City:
Province:
Postal Code:
(X1Y 2Z3)
Phone Number:
(123-456-7890)
Email Address:
(xxx@yyyy.zzz)
Type of risk:
Long Houling
Wood Chip Hauling
Finished Lumber
Sand and Gravel
Other
Years of experience:
Present Insurer:
Expiry Date:
(dd/mm/yyyy)
Claims History last 5 years:
Conviction History last 5 years:
Radius of operation:
Province & Average Distance Travelled:
If any U.S. operations,
please advise:
Driver Information
Name:
Age:
Experience:
Vehicle Schedule
Year:
Make:
Model:
Limit Price:
List Price New/Actual Value:
Coverages
Liability Limit:
$1,000,000
$2,000,000
$5,000,000
All Perils Deductible:
Comments:
