WAYFARER INSURANCE BROKERS LIMITED


For Rental Insurance premiums and coverage details, please contact our Rental Insurance office at 1-866-848-9146 or via email at amartin@wayfarerinsurance.com



DRIVER INFORMATION
(Only 4 approved drivers permitted per rental. All drivers must have a G license for a minimum of 8 years which excludes a G1 & G2)

NAME ADDRESS TELEPHONE
1. Princ.
Res.
Bus.
2. Occ.
Res.
Bus.
3. Occ.
Res.
Bus.
4. Occ.
Res.
Bus.
DRIVERS LICENCE YRS. LICENCED DISABILITIES
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2.
3.
4.

Give particulars of ALL convictions, moving violations (tickets), or claims on all drivers arising out of use or ownership of any automobile during the past five (5) years.


DETAILS OF EXISTING INSURANCE


BROKER TELEPHONE INS. CO. POLICY # COMMERCIAL
1.
2.
3.
4.


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