Payment Plan Deferral Date Request

* required  
Is this request for a fleet policy? Yes No *

Request Details

Plate or policy # *
Driver's licence #
Phone # *
Email address *
Verify email address *
Fleet policy # *
Fleet #
Fleet owner
phone #
Fleet owner email address
Verify email address
Current withdrawal date     *
Request deferred date     *

Personal information on this form is being collected under section 26 of the Freedom of Information and Protection of Privacy Act (BC) for the purpose of processing your request for a payment plan deferral. Questions about the collection of this information may be directed to