What is the insurance policy change request form template?
Mid-term changes are a big part of an agency's day: a new car, a teenager starting to drive, a move across town, a request for higher liability limits. Taken over the phone, they often arrive without a VIN, a license number or a clear effective date, and someone has to call back before the insurer can act.
This policy change request starts with the policyholder, the policy number and type, and a checklist: What do you want to change? Each tick opens its own section on the second page. A vehicle change asks for the year, make, model and VIN, what's being replaced, and any lender. A driver change asks for the driver's name, date of birth, license details and recent accidents or violations. A change of address asks for the new address, the moving date and whether it's the mailing address or where the insured property is kept. A coverage change asks which limit or deductible should move and whether a quote is wanted first.
The policyholder signs a confirmation that the change isn't in effect until confirmed and may affect the premium. Each request is filed as a PDF in your FileIt vault with any documents attached.
- Best for
- Independent insurance agencies, brokers and small insurers
- Filled in by
- The policyholder
- Time to complete
- About 3-6 minutes, depending on the changes
- Pages
- 2: policy and change type, then the details and signature
Who uses a insurance policy change request form?
- Adding a newly bought car to an auto policy
- Listing a newly licensed teenager as a driver
- Updating the address after a family moves house
- Raising liability limits before a landlord or lender asks
- Removing a driver who has moved out
- Combining a vehicle swap and a deductible change in one request
Questions on this insurance policy change request form
34 questions over 2 pages · includes signature, file upload, conditional questions, multiple pages, consent checkbox.
1 Policy & change
- Policyholder's name*
- Email*
- Phone*
- Policy number*
- Type of policy* Auto · Home or condo · Renters · Landlord · Umbrella · Business · Other
- What do you want to change?* Add, replace or remove a vehicle · Add or remove a driver · Change of address · Coverage limits or deductibles
- Date the change should take effect*
2 Details & signature
- Vehicle change* asked only when it applies Add a vehicle · Replace a vehicle · Remove a vehicle
- Year, make and model* asked only when it applies
- VIN* asked only when it applies
- Vehicle being replaced or removed* asked only when it applies
- Date bought asked only when it applies
- Is it financed or leased?* asked only when it applies
- Lender or leasing company* asked only when it applies
- Where the vehicle is kept overnight asked only when it applies
- Driver change* asked only when it applies Add a driver · Remove a driver
- Driver's name* asked only when it applies
- Date of birth* asked only when it applies
- Relationship to policyholder* asked only when it applies
- Driver's license number* asked only when it applies
- Issuing state or country* asked only when it applies
- Any accidents or violations in the last 5 years?* asked only when it applies
- Give dates and brief details* asked only when it applies
- Why is the driver being removed? asked only when it applies
- New address* asked only when it applies
- Moving date* asked only when it applies
- The new address is* asked only when it applies My mailing address only · The insured property or where vehicles are kept · Both
- Coverage change* asked only when it applies Increase a limit · Lower a limit · Change a deductible · Add a coverage · Remove a coverage
- Which coverage, and what should the new limit or deductible be?* asked only when it applies
- Would you like a quote before the change is made?* asked only when it applies
- Supporting documents
- Confirmation*
- Policyholder's signature*
- Date*
The insurance policy change request form, page by page
1 Policy & change
The policyholder gives their name, email, phone, Policy number and Type of policy, from auto and home to umbrella and business. What do you want to change? lists adding, replacing or removing a vehicle, adding or removing a driver, a change of address and coverage limits or deductibles, with Other for anything else. Date the change should take effect is required.
2 Details & signature
Only the sections for the ticked changes appear. Vehicle asks for the Vehicle change, Year, make and model, VIN, the vehicle being replaced or removed, the date bought, Is it financed or leased? with the lender if so, and where it's kept overnight. Driver asks whether to add or remove, the Driver's name, and for a new driver the date of birth, relationship, Driver's license number, issuing state or country and Any accidents or violations in the last 5 years?
Address asks for the New address, Moving date and whether it's the mailing address, the insured location or both. Coverage asks whether to increase, lower, change a deductible, add or remove, Which coverage, and what should the new limit or deductible be? and Would you like a quote before the change is made?
Everyone can upload supporting documents, then confirms the details and signs.
Make the template yours
- Remove the vehicle and driver sections if you only write property cover
- Add the carriers you place business with as a dropdown on the first page
- Make the bill of sale or registration upload required for vehicle changes
- Change the five-year lookback to the period your carriers ask about
- Add a payment method question if changes often alter the instalment plan
- File requests into a folder per producer or account manager
Tips for a better insurance policy change request form
- Tell policyholders plainly that cover doesn't change until you confirm it
- Check VINs and license numbers against the documents before sending them to the carrier
- Offer the quote-first option for coverage changes so nobody is surprised by the premium
- Confirm every change in writing with the new effective date
- Keep the signed request with the policy in your vault
Every response becomes a PDF in your vault
Each request is saved as a signed PDF in the vault folder you choose, titled with the policyholder's name and the date, with any documents attached. You're notified by email, and the policyholder can get a copy.
Work through requests from the Responses table, searching by policy number or name. Export to CSV to report on change volumes by type.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Insurance policy change request form: frequently asked questions
Is this insurance policy change form free?
Yes. It's a starter template in FileIt's Forms app on every account, and every question can be edited.
Does submitting the form change the policy?
No. It sends a signed request to you. The change takes effect once you or the insurer confirm it.
Can a policyholder make more than one change at once?
Yes. What do you want to change? is a checklist, and each ticked change opens its own section.
Will it work for home policies?
Yes. Address and coverage changes suit any policy. Remove the vehicle and driver sections if you don't need them.
Does the form calculate the new premium?
No. A coverage change can ask for a quote first, which you prepare in your own rating system.
Do policyholders need an account?
No. Share the link or email it, and they fill it in and sign without signing up.