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DL9106 (1013) Account Number: INSURANCE COMPANY/AGENCY AFFIDAVIT OF INTENDED USE INFORMATION SALES UNIT Business Type (check one): (See Reverse Side for Instructions) q Individual q Partnership q
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How to fill out penndot - insurance company/agency:

01
Gather all necessary documents: Before filling out the penndot - insurance company/agency form, make sure you have all the required documents handy. This may include your driver's license, vehicle registration, and insurance policy information.
02
Access the penndot - insurance company/agency form: Visit the official website of PENNDOT (Pennsylvania Department of Transportation) or contact your local PENNDOT office to obtain the specific form you need to fill out. They may provide a PDF version that can be downloaded and printed.
03
Fill out personal information: Start by providing your personal information, such as your full name, address, date of birth, and contact details. Double-check the accuracy of the information before proceeding further.
04
Provide your insurance details: In this section, you will need to input your insurance policy information. This typically includes the insurance company name, policy number, effective dates, and coverage details. Make sure to accurately provide this information, as any errors may cause delays or complications.
05
Include relevant vehicle details: Fill in the required information about the vehicle(s) you want to insure. This may include the make, model, year, vehicle identification number (VIN), and any additional accessories or modifications.
06
Verify and sign: Review all the information you have provided to ensure its accuracy. Inaccurate or incomplete information may affect the validity of your insurance coverage. Once you are satisfied with the details, sign and date the form as required.

Who needs penndot - insurance company/agency:

01
Drivers in Pennsylvania: The penndot - insurance company/agency form is necessary for drivers in Pennsylvania. It is a requirement by the Pennsylvania Department of Transportation (PENNDOT) to ensure that drivers have proper insurance coverage for their vehicles.
02
Vehicle owners: If you own a vehicle in Pennsylvania, you need to fill out the penndot - insurance company/agency form. It helps in verifying that your vehicle is insured, complying with the state's mandatory insurance laws.
03
Insurance policyholders: If you have an existing auto insurance policy in Pennsylvania, you will also need to complete the penndot - insurance company/agency form. This form helps in verifying your coverage details and ensures that the information is up to date with PENNDOT.
Remember, it is essential to regularly update this form whenever there are changes to your insurance policy or vehicle details to avoid any complications or legal issues. Always keep a copy of the filled-out form for your records.
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The Pennsylvania Department of Transportation (PennDOT) - insurance company/agency oversees insurance matters related to vehicles in Pennsylvania.
All insurance companies/agencies that provide coverage for vehicles in Pennsylvania are required to file with PennDOT.
Insurance companies/agencies can fill out the required forms and submit them electronically through PennDOT's online portal.
The purpose of PennDOT - insurance company/agency filing is to ensure that all vehicles on the road are properly insured and to maintain accurate records of insurance coverage.
Insurance companies/agencies must report details of the insurance policies issued for vehicles in Pennsylvania, including policy numbers, coverage amounts, and effective dates.
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