Add / Remove Driver Request Form

Policy Holder Information
Name*
First Name Last Name
Street*
City*
State*
Zip / Postal Code*
Primary Phone Number*
Alternate Phone Number
E-Mail Address*
Policy Number*
Current Insurance Provider
Add or Remove a Driver Information*
- Add a Driver - New Driver Information
- Remove a Driver - Driver Information
Add a Driver - New Driver Information
Name of Driver (First, Last)*
Gender*
Marital Status*
When will this change take effect?*
MM slash DD slash YYYY
Relationship*
License State*
License Number*
Date of Birth*
MM slash DD slash YYYY
Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?
DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after RMH Insurance has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All new policies and changes are subject to verification and underwriting approval. Customer Service hours at RMH Insurance are Monday-Friday 8:00 AM – 5:00 PM.
Remove a Driver - Driver Information
Name of Driver (First, Last)
When will this change take effect?
MM slash DD slash YYYY
DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after RMH Insurance Group has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All new policies and changes are subject to verification and underwriting approval. Customer Service hours at RMH Insurance Group are Monday-Friday 8:00 AM – 5:00 PM.

Add / Remove Driver Request Form

Policy Holder Information

Add a Driver - New Driver Information

Remove a Driver - Driver Information

RESOURCES