Group Home and Automobile Insurance Program - Application Adriatic Insurance Brokers Ltd. has partnered with the HRAC to develop a group program with AVIVA Traders General Insurance Company. Call today for a free, no-obligation quote! CALL 1-877-787-7021 Or request a quote online at www.avivatraders.com Use password: grquote Please have your existing policy on hand for faster services and identify yourself as a member of HRAC. If you prefer, complete the following form and we will send you the information.

Group Home and Automobile Insurance Program - Information Request Form Home Policy Renewal Date Auto Policy Renewal Date Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 Name Address City Province " Alberta British Columbia (property only) Manitoba (property only) New Brunswick Newfoundland Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan (property only) Postal Code Business Tel. Home Tel. E-mail Best time to call