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Brokers & Agents - Forms
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Underwriting Forms
Facility Association Common Management Attestation
Application by Broker for Appointment to a Servicing Carrier
Commercial Vehicle Supplement
Explosives Questionnaire
Fleet Rating Frequently Asked Questions
Fleet Vehicle Count Template
Facility Association Garage Rating/Underwriting Supplement (.docx)
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
Alberta
Endorsement Forms
FA 82
Deductible Amount Endorsement
Other endorsement forms and application forms can be found
here
New Brunswick
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
English
Binder Control Register
French
Binder Control Register
Newfoundland and Labrador
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
Northwest Territories
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
Nova Scotia
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
Limitation of Amount Endorsement
28a
Excluded Driver Endorsement (Nova Scotia 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)
40
Fire and Theft Deductible Endorsement
Underwriting Forms
Binder Control Register
Nunavut
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
Ontario
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
Refusal Letter
Prince Edward Island
Endorsement Forms
9
Marine Use Excluded Endorsement (amphibious automobiles)
13
Comprehensive Cover – Deletion of Glass Endorsement
16
Agreement for Suspension of Coverage Endorsement
19
Limitation 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
Yukon
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
Facility Association | Brokers & Agents - Forms