Send Declaration and Coverages Information to Lien Holder

Use this form to send declaration and coverage information to your vehicle’s lienholder. Proof of coverage may be required by your lienholder, showing your vehicle’s details, effective policy dates, and the limit of coverage carried on the vehicle. A lienholder can require the vehicle owner to purchase specific auto insurance coverages to protect their investment in case of damage or loss. Typically, comprehensive and collision coverages pay up to the depreciated value of a vehicle that has been totaled. If the depreciated value is less than what is still owed on the auto loan, it may be required to pay off the lender out of your pocket.

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

Lein Holder Information

Policy Information

To ensure the security of your information, we ask that you type the code (displayed below) in the text box. This code is an image that cannot be read by web robots and prevents them from gaining access to your information.

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

We Provide Services to the Following Cities, Towns and Surrounding Regions of NY: