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Application for Extension Automobile Policy
(Collector Vehicle) – Saskatchewan

Cherry-Insurance-classics|Insurance Saskatoon

A. Applicant Information

(Enter your name(s) as it appears on your vehicle registration)

YesNo

B. List all drivers.

 
NAME
DATE OF BIRTH(MM-DD-YYYY)
APPLICANT
NAME
DATE OF BIRTH(MM-DD-YYYY)
ADD
DRIVER 1
NAME
DATE OF BIRTH(MM-DD-YYYY)
ADD
DRIVER 2
NAME
DATE OF BIRTH(MM-DD-YYYY)
ADD
DRIVER 3
NAME
DATE OF BIRTH(MM-DD-YYYY)
ADD
DRIVER 4
NAME
DATE OF BIRTH(MM-DD-YYYY)

C. Collector Vehicle Details

 
YEAR
MAKE
MODEL
BODY STYLE
VALUE
YEAR OWNED
VEHICLE 1
Year
Make
Model
Body Style
Value
Year Owned
IS THE VEHICLE MODIFIED OR CUSTOMIZED?
YesNo
RESTORATION:

Please indicate whether the vehicle is in original condition, under restoration or previously restored.

ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED
LICENCE PLATES
ADD
VEHICLE 2
Year
Make
Model
Body Style
Value
Year Owned
IS THE VEHICLE MODIFIED OR CUSTOMIZED?
YesNo
RESTORATION:

Please indicate whether the vehicle is in original condition, under restoration or previously restored.

ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED
LICENCE PLATES
ADD
VEHICLE 3
Year
Make
Model
Body Style
Value
Year Owned
IS THE VEHICLE MODIFIED OR CUSTOMIZED?
YesNo
RESTORATION:

Please indicate whether the vehicle is in original condition, under restoration or previously restored.

ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED
LICENCE PLATES
 
IS THE VEHICLE MODIFIED OR CUSTOMIZED?
RESTORATION:

Please indicate whether the vehicle is in original condition, under restoration or previously restored.

LICENCE PLATES
VEHICLE 1
YesNo
ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED
VEHICLE 2
YesNo
ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED
VEHICLE 3
YesNo
ORIGINALUNDER RESTORATIONPREVIOUSLY RESTORED

D. Vehicle Usage

 
PLEASURE
SHOW
CLUB
BUSINESS
RACING
UTILITY-OFF-ROAD
DAILY TRANSPORTATION
OTHER*
ANNUAL KM DRIVEN
Vehicle 1
PLEASURE
SHOW
CLUB
BUSINESS
RACING
UTILITY-OFF-ROAD
DAILY TRANSPORTATION
OTHER
ANNUAL KM DRIVEN
* If other, please describe:
Vehicle 2
PLEASURE
SHOW
CLUB
BUSINESS
RACING
UTILITY-OFF-ROAD
DAILY TRANSPORTATION
OTHER
ANNUAL KM DRIVEN
* If other, please describe:
Vehicle 3
PLEASURE
SHOW
CLUB
BUSINESS
RACING
UTILITY-OFF-ROAD
DAILY TRANSPORTATION
OTHER
ANNUAL KM DRIVEN
* If other, please describe:

E. Acknowledgements - Please read before signing

While not in use, my vehicle(s) will be kept at its principal storage address in a solidly constructed, completely enclosed and locked structure.

I understand that no coverage will be provided by the policy if the described automobile, newly acquired automobile or temporary substitute automobile is being used for non-leisure use purposes. Leisure use means the described automobile is used exclusively for collector car activities, parades, and limited pleasure. Limited pleasure does not include business use of any kind, or daily driving such as but not limited to shopping or vacations neither involving nor incidental to collector vehicle activities or events.

Notwithstanding any clause to the contrary in the policy, no coverage will be provided by the policy if the described automobile, newly acquired automobile or temporary substitute automobile was being used:

  1. in any prearranged, organized, or spontaneous race or practicing or qualifying for a race. A race includes any test or contest for speed or endurance, whether against another competitor or against a time measuring device;
  2. while in any pit area, on the track or race-course or its entrance or exit lanes, whether in a supervised or non-supervised environment regardless of it being competitive or non-competitive; or
  3. while receiving or giving driving instruction with or without an instructor, or while in preparation for any such activity, with respect to any race, rally, track event, speed test, contest of any kind, competition or timed event. However, this exclusion does not apply while the described automobile, newly acquired automobile or temporary substitute automobile is:
    1. on display in a race facility’s paddock or a designated show display area;
    2. being trailered from one location to another;
    3. being operated for purposes of display in any pre-race or post-race parade laps; or
    4. involved in an organized event on open, public roads while operated within legal speed.

I understand that my coverage selection, if any, for Personal Injury Protection Plan Extension coverage is shown in my Quote Summary and any policy that may be issued to me. If I have selected this coverage extension for any of my collector vehicle(s) that are eligible to purchase this coverage, a premium will be listed under Section B of the quote or Certificate of Automobile Insurance.

I represent that in addition to maintaining the required underlying Licence Insurance for my collector vehicle(s):

  1. Each driver within my household has a regular use vehicle covered by licence insurance of which he or she is the primary operator.
  2. All of the regular use vehicles in my household are covered under their own licence insurance which is maintained in my name (if owned by me) and is in full force and effect for the entire term of the policy.
  3. In no event will the policy (if issued to me) serve as my household’s only automobile insurance policy.
Downtown
Main Branch

Hours:
Mon. to Fri. 8am - 5pm

350 3rd Avenue S
Saskatoon, SK   S7K 1M5

Erindale

Hours:
Mon. to Fri. 8:30am - 6pm
Sat. 9am - 5pm

#126 – 1820 McOrmond Dr.
Saskatoon, SK  S7S 0A6

Stonebridge

Hours:
Mon. to Wed. 8:30am - 6pm
Thurs. 8:30am - 6:00pm
Fri. 8:30am - 6pm
Sat. 10am - 6pm

#118 - 3126 Clarence Ave. S
Saskatoon, SK   S7T 0C9

Circle Drive

Hours:
Mon. to Fri. 8am - 6pm
Sat. 10am - 6pm

206 Circle Dr. E
Saskatoon, SK   S7K 0T5

North Battleford

Hours:
Mon. to Fri. 9am - 5:30pm
Sat. Closed

1392 100th St.
North Battleford, SK   S9A 0V8

Prince Albert

Hours:
Mon. to Fri. 8:30am - 5pm
Sat. 10am - 4pm

1308 1st Ave. E
Prince Albert, SK   S6V 2B1


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