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Thursday, July 24, 2008

Wawanesa Online
Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection
Limit Increase Policy Change Request

NOTE: Your current Wawanesa automobile insurance policy declaration page must indicate that you are insured for Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection in order to use this service. If your declaration page does not indicate that you are insured for Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection, please click Cancel at the bottom of this page and contact Customer Service at 1-800-640-2920 for assistance in adding this coverage to your policy.

 

To Increase Your Limit of Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection:

Please complete the following information (you will need your current policy declaration page).

1. Policy Number:
(as shown on declarations page)		 FA
2. Policyholder Name:
(as shown on declarations page)		  
3. Mailing Address:
(as shown on declarations page)		  
(number and street name)
     

(city)
 CA
+
(zip code)
4. My current limit of Coverage A. Bodily Injury Liability on my vehicle(s) is:
(as shown on declarations page)

$ 15,000 / $ 30,000
$ 50,000 / $100,000
$100,000 / $300,000
$250,000 / $500,000
5. I wish to increase Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection for all vehicles on my policy to the following limit:
Please choose your current limit for Coverage A. first.
6. E-mail Address:
Re-Enter E-Mail Address:
7. I would like this coverage to be effective on: / /
Note: Coverage will be effective at 12:01 am standard time at the address of the Named Insured as stated on the Declaration Page on the date above OR tomorrow, whichever is later.
8. I understand that if I have not answered Question 4. above correctly, this request will not be honored and no change will be made to my current policy coverage.
Yes
9. I understand that if I do not currently have Coverage G. Uninsured/Underinsured Motorists Bodily Injury Protection Coverage on my current policy, this request will not be honored and no change will be made to my current policy coverage.
Yes

Full Name of Person Completing this form:

 

Date: 7/24/2008

Time: 5:40:16 PM