Add A Driver This form will allow you to add a driver to your auto insurance policy. When you fill out this form, the information will be sent to an agent at Ullrich Insurance. We will let you know when we have an update. Keep in mind that no changes of your insurance policy are completed until you have received confirmation from us that it is completed. This is very important for you to know. Call us anytime if you have any questions about this.Your name First Last Your best email address Your best phone number Today's date MM slash DD slash YYYY Name of Person to Be Added First Last Date of Birth MM slash DD slash YYYY Drive's License Number State How is this new driver related to you? Does this new driver live in the household? Yes No Where do they live? Do they have any tickets or accidents in the past five years? Yes No What are the tickets and accidents that they have in the past five years? Which vehicle will this driver drive the most? Is this driver a student Yes No Are they in college or in high school? College High School NOTE: A college student can possibly earn a "good student discount" if they are taking at least 12 credit hours and if they have a GPA of at least 3.0 in the past emester or cumulatively.What is the name of the university? Do they have a vehicle at school? Yes No Which vehicle? Do they take 12 credit hours or more? Yes No Do they have a GPA of at least 3.0 this past semester or cumulatively? Yes No Where do you want the completed form sent?* NOTE: if an auto insurance company gives a "good student discount" to someone, they require a document from the school that shos the GPA. If they don't receive the document within a couple weeks, they will remove the discount. When we add the discount to your policy, we will ask you to send the document to us. Thank you!NOTE: A young person doesn't need to be added as a driver on your auto insurance policy if they only have their "permit." They only need to be listed as a driver if they officially have their driver's license.Does this person have their drivers license? Yes No
