Business Use (Class 30) Validation Questionnairestate Of New Jersey W-9/questionnaire Instructions Template printable pdf download

Business Use (Class 30) Validation Questionnairestate Of New Jersey W-9/questionnaire Instructions Template

BUSINESS USE (CLASS 30)

VALIDATION QUESTIONNAIRE

POLICY NUMBER: ________________

NAMED INSURED:

___________________

POLICY EFF. DATE: ______________

TRANS. EFFECTIVE DATE: ______________

CONTACT AT THE AGENCY:

______________________________________________________________

VEHICLE DESCRIPTION:

_________________________________________________________________

TO WHOM IS THE VEHICLE REGISTERED TO (as noted on the RMV-1)?

(If registered in a company name, refer to Underwriter)

______________________________________________________________________________

WHAT IS THE GROSS VEHICLE WEIGHT? (This is not the registration weight): ______________

(If GVW 10,000 pounds or more, refer to Underwriter)

WHAT IS THE BUSINESS USE? (be specific)

_____________________________________________________________________________________

______________________________________________________________________________

IS THE PRIMARY USE OF THE VEHICLE TO TRANSPORT SUPPLIES? __________________

If yes, what type of supplies: ______________________________________________________

IS THE VEHICLE USED TO SNOW PLOW: ___________

(If vehicle used to plow, refer to Underwriter)

Is an additional insured required to be listed (other than lessor, loss payee or lienholder): ___________

If yes, is a Certificate of Insurance required: ____________

IS THE VEHICLE USED TO TRANSPORT PEOPLE FOR A FEE: __________

(If yes, refer to Underwriter)

If yes, what is the number of people transported: ____________

Does the vehicle have a livery plate: ___________

IS THE VEHICLE FURNISHED FOR EMPLOYEE USE: (If yes, they must be listed as operator on

the policy and must be referred to Underwriter)

Is vehicles available to employees:

If yes, how many employees: ___________

Does this number change employees: __________

ADDITIONAL COMMENTS:

_____________________________________________________________________________________

Business Use (Class 30) Validation Questionnairestate Of New Jersey W-9/questionnaire Instructions Template