NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE
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1 NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured Insured's Address POLICY EXPIRATION DATE at 12:01 AM: This is a notice that your collision and comprehensive coverage will not be renewed. The remainder of the coverages within the policy are intact. Massachusetts law allows us to refuse collision and comprehensive coverages, under certain circumstances. This applies to the vehicles listed below. It also applies to any replacement vehicle. We are not renewing your coverage because you or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years. Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years. Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles. Insured a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at-fault accidents within the three years preceding the effective date of the policy. COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy. VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K480 (01/15) Page 1 of 2
2 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K480 (01/15) Page 2 of 2
3 NOTICE OF CANCELLATION FOR COLLISION AND/OR COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured Insured's Address Massachusetts law says we can alter your insurance. We are telling you that the coverage indicated below is cancelled. The cancellation is effective at: 12:01 A.M.. COLLISION (PART 7 or PART 8) COMPREHENSIVE (PART 9) This cancellation applies to the vehicles listed below. It also applies to any replacement vehicle. You or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years. Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years. Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles. Insured a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at fault accidents within the three years preceding the effective date of the policy. COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy. VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K481 (01/15) Page 1 of 2
4 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K481 (01/15) Page 2 of 2
5 NOTICE OF CANCELLATION FOR COLLISION AND/OR COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Insured's Address Massachusetts law says we can alter your insurance. We are telling you that the coverage indicated below is cancelled. The cancellation is effective at: 12:01 A.M.. COLLISION (PART 7 or PART 8) COMPREHENSIVE (PART 9) This cancellation applies to the vehicles listed below. It also applies to any replacement vehicle. You or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years. Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years. Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles. Insured a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at fault accidents within the three years preceding the effective date of the policy. COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy. VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K481 (01/15) Page 1 of 2
6 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K481 (01/15) Page 2 of 2
7 NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Insured's Address POLICY EXPIRATION DATE at 12:01 AM: This is a notice that your collision and comprehensive coverage will not be renewed. The remainder of the coverages within the policy are intact. Massachusetts law allows us to refuse collision and comprehensive coverages, under certain circumstances. This applies to the vehicles listed below. It also applies to any replacement vehicle. We are not renewing your coverage because you or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years. Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years. Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles. Insured a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at-fault accidents within the three years preceding the effective date of the policy. COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy. VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K480 (01/15) Page 1 of 2
8 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K480 (01/15) Page 2 of 2
9 NOTICE OF CANCELLATION FOR COLLISION AND/OR COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH Massachusetts law says we can alter your insurance. We are telling you that the coverage indicated below is cancelled. The cancellation is effective at: 12:01 A.M.. COLLISION (PART 7 or PART 8) COMPREHENSIVE (PART 9) This cancellation applies to the vehicles listed below. It also applies to any replacement vehicle. You or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrep resentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K481 (01/15) Page 1 of 2
10 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K481 (01/15) Page 2 of 2
11 NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH POLICY EXPIRATION DATE at 12:01 AM: This is a notice that your collision and comprehensive coverage will not be renewed. Massachusetts law allows us to refuse collision and comprehensive coverages, under certain circumstances. This applies to the vehicles listed below. It also applies to any replacement vehicle. We are not renewing your coverage because you or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7 or PART 8) Been involved in four or more at-fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K480 (01/15) Page 1 of 2
12 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at Massachusetts Division of Insurance. Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K480 (01/15) Page 2 of 2
13 NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH POLICY EXPIRATION DATE at 12:01 AM: This is a notice that your collision and comprehensive coverage will not be renewed. Massachusetts law allows us to refuse collision and comprehensive coverages, under certain circumstances. This applies to the vehicles listed below. It also applies to any replacement vehicle. We are not renewing your coverage because you or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY Been involved in four or more at-fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K480 (01/15) Page 1 of 2
14 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at One South Station Boston, MA Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K480 (01/15) Page 2 of 2
15 NOTICE OF CANCELLATION FOR COLLISION AND/OR COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH Massachusetts law says we can alter your insurance. We are telling you that the coverage indicated below is cancelled. The cancellation is effective at: 12:01 A.M.. COLLISION (PART 7) COMPREHENSIVE (PART 9) This cancellation applies to the vehicles listed below. It also applies to any replacement vehicle. You or a person who customarily drives the vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrep resentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7) Been involved in four or more at fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K481 (01/15) Page 1 of 2
16 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of coverage by filing a complaint in writing. Please submit to the office of The Commissioner of Insurance, at One South Station Boston, MA Complaints must be printed on a form prescribed and furnished by the Commissioner. They must be received before the effective date of cancellation. This entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of cancellation, your coverage will continue in effect. This is temporary until a determination on your appeal can be made. 61-K481 (01/15) Page 2 of 2
17 NOTICE OF NONRENEWAL FOR COLLISION AND COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH POLICY EXPIRATION DATE at 12:01 AM: WE ARE NOTIFYING YOU THAT YOUR COLLISION AND COMPREHENSIVE COVERAGE WILL NOT BE RENEWED WHEN IT EXPIRES. MASSACHUSETTS LAW PROVIDES THAT COMPANIES MAY REFUSE COLLISION AND COMPREHENSIVE COVERAGES UNDER CERTAIN CIRCUMSTANCES. OUR REASON(S) FOR NOT RENEWING YOUR COVERAGE APPLIES TO THE VEHICLE(S) DESCRIBED BELOW BECAUSE YOU HAVE OR A PERSON WHO CUSTOMARILY DRIVES THAT VEHICLE HAS: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY Been involved in four or more at-fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K480 (01/15) Page 1 of 2
18 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of this coverage by filing a complaint in writing, at the office of the Commissioner of Insurance, at One South Station, Boston, MA 02210, on a printed form prescribed and furnished by him, before the effective date of cancellation, which entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of Cancellation indicated in this notice, your coverage will continue in effect until a determination on your appeal can be made. 61-K480 (01/15) Page 2 of 2
19 NOTICE OF CANCELLATION FOR COLLISION AND/OR COMPREHENSIVE COVERAGE POLICY NUMBER: DATE OF NOTICE: Named Insured 123 Main Street Keene, NH IN ACCORDANCE WITH MASSACHUSETTS LAW AND THE PROVISIONS OF YOUR POLICY, WE ARE NOTIFYING YOU THAT THE COVERAGE INDICATED BELOW IS CANCELLED EFFECTIVE 12:01 A.M.. COLLISION (PART 7) COMPREHENSIVE (PART 9) This cancellation applies to the vehicle(s) described below, or any replacement thereof, because you have, or a person who customarily drives that vehicle has: Been convicted of vehicular homicide, auto insurance related fraud, or auto theft within the last 5 years; Made an intentional and material misrepresentation in making claim under Collision or Comprehensive within the last 5 years; Been convicted of any category of driving while under the influence of alcohol or drugs within the last 3 years. Has been issued a salvage title by the Registrar of Motor Vehicles Is a high-theft vehicle which does not have at least a minimum anti-theft or auto recovery device as prescribed by the Commissioner of Insurance. COLLISION ONLY (PART 7) Been involved in four or more at fault accidents within the three years preceding the effective date of the policy; COMPREHENSIVE ONLY (PART 9) Had two or more total theft or fire insurance claims, within the three years preceding the effective date of the policy; VEHICLE # YEAR MAKE MODEL VEHICLE ID # 61-K481 (01/15) Page 1 of 2
20 RIGHT OF APPEAL AFTER CANCELLATION You may appeal the cancellation of this coverage by filing a complaint in writing, at the office of the Commissioner of Insurance, at One South Station, Boston, MA 02210, on a printed form prescribed and furnished by him, before the effective date of cancellation, which entitles you to a hearing before the Board of Appeal on Motor Vehicle Liability Policies and Bonds. If the Board does not hear your appeal before the effective date of Cancellation indicated in this notice, your coverage will continue in effect until a determination on your appeal can be made. 61-K481 (01/15) Page 2 of 2
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