Add and/or Remove a Driver This form will allow you to add and/or remove a driver to/from your auto insurance policy. When you fill out this form, the information will be sent to an agent at Ullrich Insurance. We will let you know when we have an update. Keep in mind that no changes of your insurance policy are completed until you have received confirmation from us that it is completed. This is very important for you to know. Call us anytime if you have any questions about this.Your name First and Last name. Your best email addressYour best phone numberToday's date MM slash DD slash YYYY Where do you want the completed form sent? Do you need to add a driver, remove a driver, or both?* Add driver Remove driver Both Add DriverName of Person to Be Added First and Last name. Date of Birth MM slash DD slash YYYY Drive's License NumberStateHow is this new driver related to you?Does this new driver live in the household? Yes No Where do they live?Do they have any tickets or accidents in the past five years? Yes No What are the tickets and accidents that they have in the past five years?Which vehicle will this driver drive the most?Is this driver a student Yes No Are they in college or in high school? College High School NOTE: A college student can possibly earn a "good student discount" if they are taking at least 12 credit hours and if they have a GPA of at least 3.0 in the past semester or cumulatively.What is the name of the university?Do they have a vehicle at school? Yes No Which vehicle?Do they take 12 credit hours or more? Yes No Does this student have a GPA of 3.0 or higher? Yes No If yes, we need to have a copy of their transcripts.Max. file size: 39 MB.Does the student have a GPA of 3.0 or higher? Yes No If yes, we need to have a copy of their transcripts.Max. file size: 39 MB.NOTE: if an auto insurance company gives a "good student discount" to someone, they require a document from the school that shos the GPA. If they don't receive the document within a couple weeks, they will remove the discount. When we add the discount to your policy, we will ask you to send the document to us. Thank you!NOTE: A young person doesn't need to be added as a driver on your auto insurance policy if they only have their "permit." They only need to be listed as a driver if they officially have their driver's license.Does this person have their drivers license? Yes No Remove DriverName of Driver To Be Removed First and Last name. Why does the driver need to be removed?Is this person on a different auto insurance policy somewhere? Yes No What are the details?Is the Driver Going To School? Yes No Which School Are They Going To?PhoneThis field is for validation purposes and should be left unchanged.
