Add or Remove Driver to Existing Policy Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly. Policy Holder Information First Name*Last Name*Street*City*State*Zip / Postal Code*Primary Phone Number*Alternate Phone NumberE-Mail Address* Policy Number*Current Insurance Provider:Add or Remove a Driver Information*Add a Driver - New Driver InformationRemove a Driver - Driver Information Add a Driver - New Driver Information Name of Driver (First, Last)*Gender*MaleFemaleMarital Status*SingleMarriedSeparatedDivorcedWidowedWhen will this change take effect?* Date Format: MM slash DD slash YYYY Relationship*SpouseChildRelativeParentNon-RelativeLicense State*License Number*Date of Birth* Date Format: MM slash DD slash YYYY Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?Not SureYesNoRemove Driver from Existing Auto Policy Remove a Driver Driver Information Name of Driver (First, Last):When will this change take effect?: Date Format: MM slash DD slash YYYY DISCLAIMER: Any changes expressed over the internet can only be honored after Davidson Stewart Morelock Independent Insurance Group, Inc has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All changes are subject to verification and underwriting approval. Customer Service hours at Davidson Stewart Morelock Independent Insurance Group, Inc are Monday-Friday 8-4:30 PM. Resource Menu File a Claim Certificate of Insurance Add/ Remove a Driver Add/Remove a Vehicle Notify of a Change of Address Request Policy ID Card Request Proof of Insurance Customer Referral
