Add / Delete Driver

To add a new driver:
Your signature is NOT required for this process.
Please submit this form and send a driver's license of the new driver to Daiwa Insurance via FAX or Email.
To delete a driver
Your signature is REQUIRED for this process.
Please fill out the form below and print it. After you sign on the printed form, please send it to Daiwa Insurance via FAX or Email.

FAX#：（310）540-6554
Email： info@daiwains.com

Name Required

Phone Number (Home) Required

Phone Number (Work)

Policy Number

Effective Date Required

Type of Change Required

New Driver's Name

New Driver's Date of Birth

Sex

Marital Status

Relationship to Primary Insured

Driver's License Number

Driving Experience

Years Licensed （US）

Years Licensed （Other country if applicable）

Violations / Accidents

Removing Driver's Name

Removing Driver's Date of Birht