AUTOMOBILE POLICY — DRIVER CHANGE REQUEST

Instruction: Use this form if you need to add a new driver to or delete a driver from your automobile policy.  Once the form is submitted, it will send the information you enter to RMD for processing.  If you have any questions or problems, please contact RMD customer services at 360.902.7303.

  • Fields in Blue are required on both ADD and DELETE request types

  • Fields in Green are required on ADD only

  • Fields in Brown are optional  

  • If you want to Delete a driver, you only need to fill out the Agency Information section and the driver name.

Request type:       

ADD       DELETE   

  Agency Information:

Agency:
Effective Date:
Requestor:
Phone:
Email:
  Driver Information:
Driver Name:
Birthday:   year:
Driver License #:    State Issue:
Expiration Date:     Type:
Motor/Vehicle Record:
Years of Driving Experience:
Length of Employment:  (months)
Comments/Additional Information: