Autopac Service Request Form
HUBautomotive.ca is an easy way to manage your personal and commercial auto insurance online.
First, tell us which type of coverage you need. Select either Manitoba Personal Auto or Commercial Auto:
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Contact Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Please select your nearest branch location.
*
Winnipeg Bison Drive
Winnipeg Corydon Avenue
Winnipeg Grant Park
Winnipeg Kenaston Blvd
Winnipeg Square
Winnipeg McPhillips Street
Winnipeg Polo Park
Winnipeg Kildonan Place
Winnipeg Unicity
Winnipeg Southdale
Beausejour
Elie
Lac du Bonnet
Lockport
Niverville
Notre Dame de Lourdes
Pinawa
Portage la Prairie
Steinbach
Treherne
Whitemouth
Not sure
Curbside pick up is available at this location!
If your transaction includes something that needs to be picked up such as a licence plate and would like to have it brought out to your vehicle, our broker will arrange a pick-up time when they contact you to finish your transaction.
Office Hours:
Monday 9:00 AM - 8:00 PMTuesday 9:00 AM - 8:00 PMWednesday 9:00 AM - 8:00 PMThursday 9:00 AM - 8:00 PMFriday 9:00 AM - 8:00 PMSaturday 9:00 AM - 5:00 PMSunday Closed
Would you like curb side pick up?
Yes
No
Curbside pick up is available at this location!
If your transaction includes something that needs to be picked up such as a licence plate and would like to have it brought out to your vehicle, our broker will arrange a pick-up time when they contact you to finish your transaction.
Office Hours:
Monday 9:00 AM - 5:00 PMTuesday 9:00 AM - 5:00 PMWednesday 9:00 AM - 5:00 PMThursday 9:00 AM - 5:00 PMFriday 9:00 AM - 5:00 PMSaturday ClosedSunday Closed
Would you like curb side pick up?
Yes
No
Curbside pick up is available at this location!
If your transaction includes something that needs to be picked up such as a licence plate and would like to have it brought out to your vehicle, our broker will arrange a pick-up time when they contact you to finish your transaction.
Office Hours:
Monday 9:00 AM - 8:00 PMTuesday 9:00 AM - 8:00 PMWednesday 9:00 AM - 8:00 PMThursday 9:00 AM - 8:00 PMFriday 9:00 AM - 8:00 PMSaturday 9:00 AM - 5:00 PMSunday Closed
Would you like curb side pick up?
Yes
No
Curbside pick up is available at this location!
If your transaction includes something that needs to be picked up such as a licence plate and would like to have it brought out to your vehicle, our broker will arrange a pick-up time when they contact you to finish your transaction.
Office Hours:
Monday 9:00 AM - 8:00 PMTuesday 9:00 AM - 8:00 PMWednesday 9:00 AM - 8:00 PMThursday 9:00 AM - 8:00 PMFriday 9:00 AM - 8:00 PMSaturday 10:00 AM - 6:00 PMSunday Closed
Would you like curb side pick up?
Yes
No
Not sure? No problem. Click to see a map of our offices in Manitoba.
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Contact Information
Driver Licence Number or Customer Number (leave blank if not known). See the example below.
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What can we help you with today?
What service(s) can we assist you with? (select all that apply)
*
New Vehicle Purchase or Lease
Renewal of a Driver's Licence
Reapplication of a Lapsed Driver's Licence
Driver's Licence Replacement
Basic ID Card Replacement
Vehicle Insurance Coverage Renewal, Reassessment, Reactivation, Reapplication
Transfer
Plate/Registration Certificate
Payment
Update Mailing Address
I
First Name
Last Name
hearby authorize HUB International to make the changes outlined in this form to my automotive insurance for the following vehicle.
Year, Make, Model of Vehicle
Year, Make, Model of Vehicle
Year, Make, Model of Vehicle
Insurance Use
Pleasure
All Purpose
Lay-up in Manitoba (Storage Insurance)
Other
Third party Liability
$200,000 (Basic)
$1,000,000
$2,000,000
$5,000,000
$7,000,000
$10,000,000
Auto Loss of Use
Level 1 ($39.03/Day)
Level 2 ($68.00/Day)
Deductible
$500 (Basic)
$300
$200
$100
Leased Car Protection
Yes
No
A HUB Broker will be in contact to collect payment info through a secure method. Options include credit card or pre-authorized bank withdrawl. The payments may be made in full, in 4 payments or in 12 payments.
Are you now prohibited by court from driving or is your driver’s licence or right to obtain a driver’s licence currently suspended or cancelled?
Yes
No
When driving do you require corrective lenses (glasses or contacts)?
Yes
No
Select if you have ever had any of the following conditions which have not previouslybeen reported to Manitoba Public Insurance:
A) Seizures or blackouts?
B) Lung or heart trouble, eye diseases, stroke, diabetes treatedwith oral medication or injectable insulin, mental disorder, dementia or permanent limitation of motion?
C) Any other medical condition or physical disability that may affect your safeoperation of a motor vehicle?
If you checked off a), b) or c), the date and details of the condition(s) must be provided in the space below.
Do you hold a valid driver’s licence from another province, state or country? If “yes” state where. Provide D/L Number, Effective and Expiry Dates, D/L class.
Yes
No
Driver's Licence Number
Driver's Licence Class
Effective Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expiry Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Driver Licence Number or Customer Number (leave blank if not known)
Driver Licence Number or Customer Number (leave blank if not known)
Driver Licence Number or Customer Number (leave blank if not known)
Driver Licence Number or Customer Number (leave blank if not known)
Customer Number (leave blank if not known)
Can we assist you with any other insurance needs at this time? (select all that apply)
Home
Tenant
Condominium
Life
None
Other
When can we best contact you? (select all that apply)
*
Morning (9:00AM-12:00PM)
Afternoon (12:00PM-5:00PM)
Evening (5:00PM-7:00PM)
Any other questions or information to add? Leave blank if none.
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Athorization Confirmation
Before HUB International may process your transaction remotely, we ask that you observe the following statements.
I understand and agree that HUB International will be processing this transaction remotely on my behalf and will only take effect once a representative from HUB has contacted me to confirm the changes.
*
Yes
I authorize MPI to share my personal information with HUB International (MPI customer number, full legal name, date of last visit to the agent's office, renewal date of driver licence, vehicle registration and ID card, mailing/email address, telephone/fax numbers)?
Yes
I consent to HUB International sending me electronic messages about products, services, and offerings that may be of interest to me (I understand that I may withdraw my consent at any time by notifying Manitoba Public Insurance).
Yes
I understand the 1-Piece MB Driver Licence will be mailed to the address shown on my MPI account within 30 days.
Signature
*
Date
*
Submit
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Saskatchewan Personal Auto
You can complete auto transactions online through MySGI. Click on your nearest location from the list below.
Broadview
Delisle
Dodsland
Emerald Park
Esterhazy
Estevan
Fort Qu'Appelle
Grenfell
Indian Head
Kamsack
Kelliher
Kindersley
Kipling
Langenburg
Lemberg
Lipton
Montmartre
Moosomin
Pilot Butte
Prince Albert
Qu'Appelle
Rose Valley
Vonda
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Commercial Auto
Name
*
First Name
Last Name
Email
*
example@example.com
Policy Number
If you do not currently know your policy number, please contact your HUB Advisor directly or call 1.866.259.6940
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Manitoba/Saskatchewan Commercial Auto
Additional Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
Serial Number/VIN
17 Digits
Principle Operator of Vehicle (If Applicable)
Purchase Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Vehicle Value
Who is the legal owner of the vehicle(s)
*
Who will be the registered owner of the vehicle(s):
*
Is the vehicle being financed or leased?
*
Yes
No
Please state the name and address of the Financing/Leasing Company (Not the dealership):
*
Is there a tarmac exposure?
*
Yes
No
Will the vehicle carry passengers for compensation as a taxi?
*
Yes
No
Will the vehicle carry passengers for compensation as a private bus?
*
Yes
No
Will the vehicle be carrying and delivering goods for others?
*
Yes
No
If yes, radius of operations
*
Will the vehicle be carrying and delivering goods for the Insured's own operations?
*
Yes
No
Vehicle weight
*
Is there any equipment attached to the vehicle?
*
Yes
No
Submit
Should be Empty: