Online Request for Taxi Insurance – PAGU Discover the different types of coverage available, and we will guide you to the one that best suits your needs! General Information of the Taxi Owner First Name Last Name Address City Postal code Phone Number Are you the only driver of your vehicle? Yes No Driver's Declaration First Name (optional) Last Name (optional) Date of birth (optional) Member number (optional) Driver's license number (optional) Number of years of experience in class 4C (optional) Has the SAAQ added any conditions to your license, such as wearing glasses Yes No How long have you owned your own taxi (optional) Which metropolitan area do you depend on (optional) Have you been involved as an owner or user of a motor vehicle taxi, in any claim(s), with or without indemnity, in the last 4 years. Yes No Have you been convicted or disqualified from driving as a motor vehicle operator under the Highway Traffic Act or the Criminal Code in the past 3 years Yes No Has your driver's license been suspended or revoked in the last 5 years? Yes No Do you or any member of your household have a criminal record? Yes No Information About the Taxi Vehicle year (optional) Vehicle make (optional) Vehicle model (optional) Vehicle VIN (optional) Vehicle value (optional) Plate number (optional) Taxi dome number (optional) Do you have a GPS dispatch system for taxi calls Yes No Is the vehicle modified for specialized transportation Yes No Do you have a POS (credit card modem): Yes No Information on the Use of the Vehicle Vehicle use (optional) - None -TaxiLimousineSpecialized TransportationOther activities Is the vehicle used exclusively as a taxi Yes No Advertising signs on the vehicle Yes No Information on your current insurer Previous insurer (optional) Policy number (optional) Has an insurer cancelled your policy or refused to renew it Yes No Insurance Coverages Requested Chapter A - only Civil Liability Yes No Chapter B1 - All Risks Yes No Chapter B3 - Collision and Comprehensive Car Insurance: Yes No Important Notes The insurances that may result from the above statements are subject to the provisions and clauses of the Quebec Automobile Insurance Policy Q.P.F. No 1. It is mandatory to include the driver's recent driving record (no more than three (3) months). By submitting this form, I authorize and request any present and former insurer and/or employer to provide Royal & Sun Alliance Insurance Company of Canada and its agents with a detailed list of claims incurred and any other information, personal or otherwise, relevant to the formation, performance and monitoring of this contract.
