Endorsement Request Form - New Brunswick
Please fill in only the information that is required for your change. If something doesn't partain to the change, please leave it blank.
There are 2 areas for uploading all supporting documents needed for the endorsement. All documents you add will be emailed to email@example.com once you've clicked submit.
A copy of the request and documents uploaded will also be sent to the broker email address entered.
Description of change needed
Endorsement Effective Date MM/DD/YYY
Broker Phone #
Insured's Address - Please enter if address has changed
State / Province / Region
Postal / Zip Code
Please enter unit details here - If adding more than one unit, enter additional units and coverage in remarks at the bottom.
Trail Bike - If plated for road use, please specify in remarks below.
Is the Unit New or Used?
If the Unit is New, is the 43R endorsement required?
Delivery Date DD/MM/YYYY
If new, include unit price, taxes, modifications and freight.
Please select coverage.
Third Party Liability
Mandatory Coverage with TPL
Health Service Levey
Direct Compensation & Property Damage
SEF 44 - Family Protection (Optional)
Including any modifications.
Section C Upload
Please add the Inspection, Bill of Sale, or current insurance if Sec C is required.
$500 - Manditory
$1000 - Optional
43R - Limited Waiver of Depreciation
Modifications - Include value of modifications
Optional - Truck Deck or Trailer - Include Value
Lien Holder (if applicable) include name, address, city, prov and postal code.
Name of Principle Operator
Date of Birth DD/MM/YYYY
Drivers Licence #
Years Riding Experience
# of convictions in the last 3 years
# of claims in the last 3 years
Safety Course - AQCC/CASI or Canadian Safetly Counsel?
Is the Insured a member of;
NBATVF - ATV's only
NBSF - SM only
Additional Information - Please fill out all the information that applies to your change request.
Turbos, after market enhancements or added equipment designed to modify or enhance the performance?
After Market Performace Enhancement Equipment
Added Equipment (Tracks)
Other - add in remarks
If the unit is a Trail Bike, will it have tracks?
If tracks will be added at anytime during the policy please check yes even if they aren't currently on.
Safety Immobilizer or Spot Trace tracking device?
Business Use - if applicable
Is there business use on any units?
If there is buiness use on any of the units please fill out the information below.
% of Business
% of Pleasure
How many KM driven anually?
Please describe the nature of the business
Please upload all supporting documents, these documents will be automatically emailed with your request to Oasis once submitted.