Musical Instrument Insurance : Step 1 - Change Request Form
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What Does it Cover?
Get a Quote for Your Musical Instrument
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How to Make a Claim
Change Your Policy or Personal Information
Certificate Number:*
Personal Information
Name of Policy Holder:*
Address:*
City:*
Province:*
Select One
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Postal Code:*
Telephone:*
Fax:
Email:
Personal Information Change
Only fill in the information that you want changed.
Name of Policy Holder:
Address:
City:
Province:
Select One
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
North West Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code:
Telephone:
Fax:
Email:
Changes to Your Policy
Check off all that apply
Add an Instrument
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3
How many instruments do you want to add?
Change the value of an Instrument
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1
2
3
How many instruments will have their value changed?
Delete an Instrument
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1
2
3
How many instruments do you want to delete?