Waiver Of Deductible

Waiver of Deductible

I, the undersigned, with insurance policy number {number} at {Insurance Company}, hereby confirm that I have purchased {Collision Coverage Type} and {Uninsured Motorist Collision Type}, and that—for the duration of time that I have both coverages through {Insurance Company}, I would like to waive my collision deductible for the following vehicle(s):

• {Vehicle Year, Make Model}
• {Vehicle Year, Make Model}
• {Vehicle Year, Make Model}
• {Vehicle Year, Make Model}

____________________________________

Signature & date

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