Your Insurance Self-Serve Centre | Mitchell & Whale Ltd.

Easily manage your policy when it’s convenient for you.

COVID-19 Coverage Updates

Select Form:

Change Address

Please complete all fields within the form below.

First Name

Last Name

Email Address

Policy Number

Current Address

New Address

Current Phone Number

New Phone Number

Effective Date of Change

New KM Distance to Work, One-way

Total Annual KM Driven

Other Licensed Drivers in Household? Yes No

If you have your home, condo or tenants insured with us we have a bunch more info we’ll need. Check this box and we can have a broker reach out to gather the additional information.

Driver #1

First Name

Last Name

Name of Insurance Company

Policy Number

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

Add Vehicle

Please complete all fields within the form below.

First Name

Last Name

Email Address

Phone Number

Policy Number

Is this vehicle New or Used?

# of KM’s at Purchase

Is Vehicle Leased or Financed?

Vehicle Purchase Price

Name of Lienholder or Lessor

Address of Lienholder or Lessor

Vehicle Purchase Date

Vehicle Year

Vehicle Make

Vehicle Model

VIN of New Vehicle

Effective Date of Change

Modified or Customized Yes No

Description

Unrepaired Damage Yes No

Description

Used for Carpooling or Uber Yes No

Description

# of KM driven one way to work

Annual KM driven

Who will be the primary driver of this vehicle

Winter Tires Yes No

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

A copy of the vehicle ownership and bill of sale(for new vehicles) is required. Please email a copy/photo of both to service@mitchellwhale.com to complete the file.

Substitute Vehicle

Please complete all fields within the form below.

Which vehicle to be substituted?

First Name

Last Name

Email Address

Phone Number

Policy Number

Is this vehicle New or Used?

# of KM’s at Purchase

Is Vehicle Leased or Financed?

Vehicle Purchase Price

Name of Lienholder or Lessor

Address of Lienholder or Lessor

Vehicle Purchase Date

Vehicle Year

Vehicle Make

Vehicle Model

VIN of New Vehicle

Effective Date of Change

Modified or Customized Yes No

Description

Unrepaired Damage Yes No

Description

Used for Carpooling or Uber Yes No

Description

# of KM driven one way to work

Annual KM driven

Who will be the primary driver of this vehicle

Winter Tires Yes No

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

A copy of the vehicle ownership and bill of sale(for new vehicles) is required. Please email a copy/photo of both to service@mitchellwhale.com to complete the file.

Change Vehicle

Please complete all fields within the form below.

First Name

Last Name

Email Address

Address

Phone Number

Policy Number

Year of Vehicle to be Changed

Make of Vehicle to be Changed

Model of Vehicle to be Changed

VIN of Vehicle to be Changed

Reason For the Change

Coverage to be Changed

Effective date of Vehicle to be changed

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

Remove Vehicle

Please complete all fields within the form below.

First Name

Last Name

Email Address

Phone Number

Policy Number

Year of Vehicle to be Deleted

Make of Vehicle to be Deleted

Model of Vehicle to be Deleted

VIN of Vehicle to be Deleted

Effective Date of Deletion

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

Add Driver

Please complete all fields within the form below.

First Name

Last Name

Email Address

Address

Phone Number

Policy Number

Effective Date of Change

First name of Driver to be Added

Last Name of Driver to be Added

Marital Status of the Driver

Licence Class

Sex

Driver’s Licence Number

G1 Date

G2 Date

G Date

Birth Date of the Driver

Relationship of Driver to Policyholder

Does This Driver Have Authorization to Make Inquiries or Changes to Your Auto Policy?

Province in Which This License is Held

Driver’s Training Yes No

A copy of the Drivers History Report required. Please email copy of the Drivers History Report to service@mitchellwhale.com to complete the file.

Any claims in the last 6 years Yes No

Description

Any tickets in the last 3 years Yes No

Description

Any driver’s licence suspensions in the last 3 years Yes No

Description

Prior Insurance Yes No

Description

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

A copy of the drivers licenceis required. Please email a copy/photo of the licence to service@mitchellwhale.com to complete the file.

Request Policy Documents

Please complete all fields within the form below.

First Name

Last Name

Email Address

Address

Request Document

Details

Policy Number

Phone Number

Method of Delivery?

Fax

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

Cancel Policy

Please complete all fields within the form below.

First Name

Last Name

Email Address

Address

Policy Number

Phone Number

Effective Date of Cancellation

Reason for Cancellation

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

Additional Comments

Thank you for completing this form. A signature from all named insureds on this policy is required to cancel the policy. We will provide you with the required documents to sign based on the information provided on this form.

General Enquiry

Please complete all fields within the form below.

First Name

Last Name

Email Address

Phone Number

Select preferred method of contact? By Email By Phone

Contact Email

Best time to contact you

How Can We Help?

Thank you for completing this form.

Self-Serve Centre

Easily manage your policy when it’s convenient for you.

Driver #1

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