Add / Delete Vehicle

Please read a following direction carefully.
After receiving your request, we will process it and contact you for confirmation as soon as possible.

To add a new vehicle Your signature is NOT required for this process. Please submit this form and send one of the required documents* listed below to Daiwa Insurance via FAX or Email.
To delete a vehicle Your signature is REQUIRED for this process. Please fill out the form below and print. After you sign on the printed form, please send it to Daiwa Insurance via FAX or Email.
To replace a vehicle Your signature is REQUIRED for this process. Please fill out the form below and print. After you sign on the printed form, please send it to Daiwa Insurance via FAX or Email, along with one of the required documents* listed below.

*Required documents
- Sales Contract - Registration
- Certificate of Title

FAX#：（310）540-6554
Email： info@daiwains.com

Name Required

Phone Number (Home) Required

Phone Number (Work)

Policy Number

Effective Date Required

Type of Change Required

Year

Make

Model

Vehicle Identification Number

Coverage

If changing a coverage, please describe：

Year

Make

Model

Vehicle Identification Number