Get National Indemnity Drive Away Program Form

Filling out the National Indemnity Drive Away Program Form online can streamline the process of obtaining insurance for your drive-away operations. This guide provides clear, step-by-step instructions to help you complete each section of the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the first section, enter your legal name, trading name (if applicable), and select the business structure — either Individual/Proprietorship, Partnership, Corporation, or Other. Provide the business phone number.
3. Fill in your mailing address, including the city, state, and zip code.
4. Input the premises address where your business operates, also including city, state, and zip code.
5. Next, provide the name and phone number of the person to contact for inspection.
6. Indicate whether you have previously had insurance with any of the listed companies by selecting 'Yes' or 'No.' If 'Yes,' provide the effective dates and policy numbers.
7. Describe your business operations clearly in the 'Description of Operations' section, including years of experience and whether this is a new venture.
8. Specify if this is your primary business by selecting 'Yes' or 'No.'
9. Indicate whether you have filed for bankruptcy. If 'No,' provide an explanation.
10. Enter your gross receipts from the last year and your estimate for the coming year.
11. Answer if you operate in more than one state and if you operate over a regular route.
12. In the Liability Coverage section, complete the desired coverage limits based on your requirements.
13. Provide driver information by listing each driver's name, date of birth, driver's license number, and driving experience.
14. Answer questions regarding drivers' previous accidents and violations.
15. Complete the Loss Experience section with details of your past insurance carriers for the last three years.
16. Complete the Drive-Away Information section, answering questions about types of units, driving payments, and operations.
17. In the Uninsured/Underinsured Motorist Election Form section, indicate your choice of coverage limits.
18. Ensure that you provide all necessary signatures at the end of the application before submitting.
19. Finally, save your changes, download a copy, print, or share the completed form as required.

Take the next step and complete your National Indemnity Drive Away Program Form online today!