Address Change Form

This form will allow you to make a change of address to your policies. Make sure you have your current insurance certificate or policy on hand.

One of our Customer Service Representatives will review your file and will contact you if your move impacts your insurance policy (for example, the distance you drive to work may have changed or you have a new house to insure).

For your added protection, any change you make to your policy does not become effective until we contact you to verify the change and effective date. This is to protect your existing coverage, should additional information or coverage be required to make the change you have asked.

About you

Name(s) of insured(s)
(as named on your policy)   

1^st Named Insured:

2^nd Named Insured:

We can only accept changes from policyholders.
Please check this authorization box, before completing the rest of the form :
 

 I'm the owner of the policy and I'm authorized to submit these changes.

Disclaimer

Your preferred means of communication for contact and follow-up :
 

E-mail

Phone

E-mail address :

Daytime telephone number :  

Area 204 250 289 306 403 416 418 450 506 514 519 604 613 647 705 709 780 807 819 867 902 905     Ext. : 

Home telephone number :

Area 204 250 289 306 403 416 418 450 506 514 519 604 613 647 705 709 780 807 819 867 902 905   

Prior address

New address

Policy

Company

If other,
specify

Type
of
insurance

Insurance
policy
number

1

Select ING Insurance ING Novex ING Western Union Other

Select Auto Property Combined Business Other All

2

Select ING Insurance ING Novex ING Western Union Other

Select Auto Property Combined Business Other All

3

Select ING Insurance ING Novex ING Western Union Other

Select Auto Property Combined Business Other All