Aviva COVID-19 Relief

By completing this form, the named insured or the Broker representative on behalf of the named
insured, agrees that the vehicle(s) are:
• Only being used for essential purposes such as getting groceries or picking up medication.
• Not being used for business or to commute to work or school.
• Not being used for commercial purposes including delivery.

  • Vehicle Information

  • OR, if not all vehicles on the policy are being used for pleasure, please list those that are:
  • • Once the form is submitted a policy change document and details of your savings will be sent to you.
    • If your driving habits change before 90 days, please notify your Brokerage. If not, your policy information will revert back to the original state after 90 days.