ALBERTA AUTOMOBILE QUOTE | A-Kan Insurance

Vehicle Details	Vehicle 1	Vehicle 2	Vehicle 3
Principal Driver
Use	PersonalWork	PersonalWork	PersonalWork
Year, Make, and Model
VIN#
Lienholder	YesNo	YesNo	YesNo
Annual Mileage

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Driver Details	Driver 1	Driver 2	Driver 3
Consent	YESNO	YESNO	YESNO
1st Name & Last Name
DOB
Marital Status
Occupation
Driver’s License #
Years Licensed
First Insurance in Canada
Driving Training Completed?	YESNO	YESNO	YESNO
Tickets
Accidents
Major/Criminal Convictions
Suspensions
Cancellation for Non-Payment

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