Add Vehicle

About You

Name(s) of insured(s) *:

How can we reach you?
E-mail address:
Daytime telephone #:
Home telephone #:
Fax #:

New Vehicle

Vehicle make:
Condition at time of purchase:
Purchase date (dd/mm/yy):
Purchase price:
VIN (vehicle ID #):

Any non-factory modifications to the vehicle?
Any unrepaired damage?
If yes, please specify:
Is vehicle leased or financed?
If yes, specify:
Names and address of leasing company lien holder:
Use of vehicle:
Comments (details if use is other):
Kilometres traveled per year:
How many kilometers one-way for daily commute?
Will adding this vehicle result in changes in use of other vehicles owned?
Third party Liability coverage requested:
Collision coverage and deductible requested:
Comprehensive coverage and deductible requested:
All perils coverage and deductible requested:

Driver Information
(for all drivers who will be operating this vehicle)
Driver #1Driver #2Driver #3
Date of birth (dd/mm/yyyy):
Driver type:

Effective Date

When will this change be effective? (dd/mm/yyyy)

About Your Insurance

(Specify the policy to which this change applies)

Policy #:
Additional Comments:
Name of your broker:
How did you hear about us?

"I know all my insurance needs are covered with Oegema, Nicholson & Associates. I have been a loyal client for the last 15 years, and I can count of them for my commercial insurance, employee benefits, as well as my personal insurance and finances. Jeff Richer always goes above and beyond to help me with my insurance needs."
O-Omkar Atwal, Owner, Leitrim Home Hardware
"It’s always a pleasure to deal with Oegema, Nicholson & Associates, and I can depend on them for all my insurance needs. I have been a client for several years and whether it’s regarding my personal insurance, or anything to do with our employee benefits or commercial needs, I know I’m taken care of."
R-Rhonda, Capital Dodge
"I would like to thank Carol for everything she has done for me and my family over the years. It is my honest belief that we would not be in the position we are in if it was not for her guidance, expertise and honesty. We can't begin to thank her enough."
"ONA helps me with my personal insurance and my business insurance . They are my one stop shop when it comes to insurance and group benefits. I know I’m covered in all areas. Great friendly service and knowledgeable staff!"
J-James Carriveau, President, Exact Interlock and Exact Properties
"One call to Oegema, Nicholson Associates is all it took. After our basement flooded, within a day or two they had a crew cleaning everything up, taking down the drywall and itemizing everything to be cleaned, thrown out or restored. They had everything in place for us in a timely manner and were extremely patient with me as they talked me through the process and waited for me to make decisions."
J-Jennifer Parks, Stittsville, Ontario
"I’ve been dealing with ONA for over 20 years with my personal insurance, as well as our commercial insurance, and I know I can rely on them for great customer service, and prompt responses. I feel confident not only referring them to my employees, but to our customers as well."
C-Charlene Brunet, President, Dan Murphy Ford
Oegema, Nicholson Financial Inc.
1451 Woodroffe Avenue
Ottawa, Ontario K2G 1W1
5526 Manotick Main Street P.O. Box 149
Ottawa, Ontario K2G 1W1
154 Bridge Street P.O. Box 749
Almonte, Ontario K0A 1A0
243 Castor Street
Russell, Ontario K4R 1B8
3-3809 St. Joseph Blvd.
Orleans, Ontario K4A 0Z8
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