motor racing questionnaire - sun life financial · motor racing questionnaire types(s) of racing...
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Motor Racing Questionnaire
Types(s) of racing engaged in:
Auto crash: � T-bone, Rollover, Dive Bomber, etc. Kart � Enduro, Sprint� Demolition Derby � Experimental, others
� Grand Touring (including Trans-Am Midget/Sprint car: � 1/4, 1/2 and IROC)
� 3/4 Full (Outlaw) � Record attempts� IMSA GT
Drag Racer: � Top Fuel Dragster, Funny Car, Prostock (PRO) � Indy Light Car� Other or Amateur � Vintage or other sports car racing
� Off-Road (Baja 500, Mexican 1000, etc.)Rally: � Professional � Stock car (Specify type)
� Other or amateurRecord Attempts � Sedan Racing (BMW, Audi, etc.)
Jet Car: � Exhibition � Time trials� Record attempts � Pleasure or � Income
Sports Cars: � Can-Am Professional Training � Yes � No � Other _________________� Formula car (Specify type):
Make(s), model(s) and engine size(s) of vehicles(s): _____________________________________________________________________________
______________________________________________________________________________________________________________________________
E19-06-05
Where do you race? What type(s) of surface(s) do you race on? What type(s) of course(s) do you race on?
How often do you race? Last 12 months? Next 12 months? Name of Sanctioning body
Name (first, middle initial, last) Date of birth (d/m/y) Policy no.
________________ - __Advisor’s name Advisor’s no.
The product you are applying for is issued by Sun Life Assurance Company of Canada
1 | Automobile racing
2 | Motorcycle racingTypes(s) of racing engaged in:
� Drag Racer: � Top Fuel � Road racing (Grandprix or Productions): � Stunt riding, acrobats, daredevils,� Modified � Street or stock Engine size: _____________ cc time trials or speed record attempts
Make and model: __________________________________________ Professional Training � Yes � No
� Pleasure or� Motorcross: � Income
Engine size: ___________ ccMake and model: ______________________________________________
� Speedways (Ovals): � Other ____________________________Engine size: ___________ ccMake and model: ______________________________________________
3 | Powerboat racingTypes(s) of racing engaged in: (check the boxes that apply)
� Stock � Offshore racing � Other
4 | Complete in all cases
Declaration: I declare that the answers and statements to the above questions are full, complete and true and shall form part of my appli-cation for insurance on my life with the Sun Life Assurance Company of Canada. I understand that if I do not fully, completely and truth-fully answer the above questions (if I misrepresent my answers or statements) the Company may void the policy.
Signature of Insured person Date (d/m/y)
X
Please send fax or original.