Cheep Insurance - Add Vehicle Request

Policy Information
Policyholder Name*
Email Address*
Primary Phone Number*
Personal Information Consent*
- Yes, I Consent
For the purposes of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or change in coverage and payment thereof, I authorize Cheep Insurance and/or its insurance suppliers, on behalf of myself and other applicants/policyholders listed to collect, use and disclose personal information, including relevant reports containing policy and claim history up to 25 years, for the purposes of assessing, managing and underwriting risk, determining a premium, establishing eligibility for a premium payment plan (as applicable), investigating and settling claims, analyzing business results, detecting and preventing fraud as permitted by law and in accordance with its privacy policies. I understand that Cheep Insurance is gathering this consent on behalf of multiple insurance companies and that I can withdraw my consent at any time.
Change Request Information
What date would you like the change to take place?*
MM slash DD slash YYYY
Will you be the registered owner of the vehicle you'd like to add to the policy?*
- Yes, I am the registered owner of the vehicle
- No, I am not the registered owner of the vehicle
Note: you have 30 days to register the vehicle in your name after adding it to your policy. If the vehicle will be registered to you within 30 days, please answer "Yes" to this question.
UNABLE TO ADD VEHICLE TO POLICY

Please note that you cannot add this vehicle to your policy because you are not the registered owner. You cannot insure something you don't own. The owner of the vehicle will need to set up their own insurance policy in their name and insure the vehicle that way.

If the vehicle is (or will be) registered to your spouse or commonlaw partner, we can add them as a policyholder on your policy and add the vehicle to the policy. If this is the case, please give us a call at 1.866.922.4337 and explain the situation and our team will walk you through next steps.
Vehicle Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
VIN#*
Vehicle Use
Do you use your vehicle to drive to work or school?*
- Yes
- No
Use of Vehicle
How do you travel to work or school?*
Commute
How many km do you drive one way to work or school?*
How many km do you drive your vehicle in a year? (Approx.)*
Is the vehicle used for business purposes at all?*
- Yes
- No
Business Use
Please describe the business use?*
Vehicle Coverage
What liability limit (PL&PD limit) would you like for this vehicle?*
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle
Would you like collision coverage for this vehicle?*
- Yes
- No
Collision coverage pays for the cost of repairing or replacing your vehicle up to the actual cash value if it collides with another vehicle, the ground, or an object on the ground such as a guard rail less the deductible you choose.
Collision Coverage
Which deductible would you like to go with for your collision coverage?*
- $250 Deductible
- $500 Deductible
- $1,000 Deductible
Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Would you like comprehensive coverage for this vehicle?*
- Yes
- No
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose
Comprehensive Coverage
Which deductible would you like to go with for your comprehensive coverage?*
- $250 Deductible
- $500 Deductible
- $1,000 Deductible
Please choose the deductible you would like for Comprehensive coverage. The deductible is the amount you are responsible to pay in the event of a comprehensive claim.
Would you like Accident Protection Coverage*
- Yes
- No
With this coverage, your first at-fault accident will be “forgiven”. This means your premium won't increase as a result of the accident, for as long as Accident Protection remains on your car insurance policy and you remain with the same insurance carrier.
Replacement Rental Car (Sef 20 - $1200 Limit)*
- Yes
- No
Provides coverage for reasonable expenses incurred for a rental vehicle or other transportation, if the insured vehicle is not able to be driven due to an insured loss or insured damage. Coverage limits apply (limits vary by carrier).
Extending your coverage to a Rental Car (Sef 27 - $40K Limit)*
- Yes
- No
Covers you for damage to a rented private passenger vehicle should you have an at-fault accident – coverage is based on your policy limits and for a specified vehicle value limit.
Emergency Roadside Service Coverage - (Sef 35)*
- Yes
- No
Provides reimbursement for towing and emergency service expenses if the vehicle is disabled (e.g. flat tire, breakdown). Does not cover the cost of parts, supplies, etc. Damage does not have to be from an insured peril for this coverage.
Waiver of Depreciation Coverage (Brand New Vehicle Only) - (Sef 43R)*
- Yes
- No
A depreciation waiver means your car insurance policy will pay out the full purchase price for your vehicle if it is stolen or damaged beyond repair in an accident (no depreciation will be applied). This coverage will apply for a set period of time after the new vehicle is purchased.
Is there a lease or financing on the vehicle?*
- Yes - I'm leasing it
- Yes - I'm financing it
- No
Full name & address of the lessor (company you're leasing from)
Full name & address of the lienholder (lender)
Is the vehicle modified in any way?*
- Yes
- No
Modifications
Please describe the modifications.*
Condition of the Vehicle*
- New
- Demo
- Used
How Many KM were on the vehicle when purchased*
Date of Purchase*
MM slash DD slash YYYY
Is there any existing damage to the vehicle?*
- Yes
- No
Existing Damage
Please describe any existing damage to the vehicle?*
Driver Information
Who drives this vehicle primarily?
First Last
Is there anyone living with you that has a drivers license and does not have their own insurance policy?*
- No
- Yes
Additional Driver 1
Name*
First Name Last Name
Driver’s License Number*
Relationship to You*
Which vehicle do they drive and how often?*
Additional Driver 2
Name
First Last
Driver's License Number
Relationship to you
Which vehicle do they drive and how often?
Discount Information
Does your vehicle have snow tires?*
- Yes
- No
Does your residence have private parking?*
- Yes
- No
A discount could be available for all private passenger vehicles with a private space for parking, such as a private garage, driveway, or carport.
Do you consent to a soft credit check to determine if you’re eligible for a credit-based discount (up to 30% savings)?*
- Yes
- No
Some of the insurance companies we work with are now offering discounts based on soft credit check results. This does not impact your credit score, and we don't see your credit information, the system just determines the discounts available.
Credit Consent Statement*
- Yes, I Consent
For the purposes of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or change in coverage and payment thereof, I authorize Cheep Insurance and/or its insurance suppliers, on behalf of myself and other applicants/policyholders listed to collect, use and disclose personal information, including relevant reports containing policy and claim history up to 25 years and credit information, such as my credit score, as applicable to the insurance company supplier, for the purposes of assessing, managing and underwriting risk, determining a premium, establishing eligibility for a premium payment plan (as applicable), investigating and settling claims, analyzing business results, detecting and preventing fraud as permitted by law and in accordance with its privacy policies. I understand that Cheep Insurance is gathering this consent on behalf of multiple insurance companies and that I can withdraw my consent at any time.
Comments
Do you have any other comments to make for this change?

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