Full Name *

Email *

Phone *

What type of vehicle service do you need help with? *

Add Replace Vehicle

Remove Veh or Cancel Plates

Reinstate Coverage or Prevent Cancellation

Request Policy Documents

Reinstate Coverage or Prevent a Policy Lapse

Billing Payment

Loss Run

Cancel Entire Auto Policy

Make Another Policy Change

Briefly describe what you're trying to do* *

Date of Request

Where are you Obtaining it from? New Veh

Dealership

Private Party

Other

Are you Adding or Replacing a Vehicle? AR

Adding

Replacing

Driver's Name & License Number: ARV

Your Vehicle Make/Model/Year: ARV

Which vehicle are you replacing? ARV

Please email completed RTA or paperwork to: [email protected]

Submitting this request or emailing the RTA does not add or replace a vehicle or activate coverage. Coverage is not effective until the stamped documents have been processed & confirmed.

What do you need to do?

Remove a vehicle—plates already canceled

Transfer Plates to New Vehicle

Cancel Mass Plates & Remove Vehicle

Why is the vehicle being removed?

Sold / Traded / Donated

Totalled

No Longer Used

Insured Elsewhere

Other

Vehicle Make/Model/Year_Remove:

Vehicle Plate # (if known_Remove

Requested Veh Removal Date

Need to cancel your Massachusetts registration?

Cancel your vehicle registration through the Massachusetts RMV

After completing the cancellation, download the Registration Cancellation Receipt and upload it below. Do not drive the vehicle after its registration has been canceled.

Upload Registration Cancellation Receipt — if applicable or Email to: [email protected]

Click to upload

What do you need to do? Prevent-Reinstate

Prevent a pending policy lapse

Reinstate a lapsed policy

I received a late-payment or lapse notice

Unsure

Have you made the required payment or completed the requested action?*

Yes

Unsure

Cancellation date shown on the notice_Pvt-Rist

Briefly tell us what happened

What document do you need?

Policy summary or annual statement

Full policy contract

In-force illustration

Beneficiary designation confirmation

Cash value or policy-loan statement

Tax document

Premium or billing document

Other

Where should we send it?

Send it to me

Send it to another person or company

If Another Person or Company: Name & Email

What Billing Payment Help do you Need?

Make a premium payment

Understand my premium notice or bill

Payment was not applied

Update my payment method

My premium changed

Refund question

Other

Briefly explain the issue

How many years do you need?

Three Years

Five Years

Unsure

Where should we send it?_Loss Run

Send it to me

Send it to another person or company

Another Person or Company: Name & Email_Loss Run

Requested cancellation date

Why are you canceling?

I have replacement insurance

All vehicles were sold

Coverage is no longer needed

I moved out of state

Other

Do you have replacement insurance?*

Yes

Not applicable

What happened to the Massachusetts plates?

Transferred to the replacement policy

Registration canceled

Not completed yet

Not applicable

Policy Number_Cancel Veh

Vehicle Make | Model | Year_Cancle

Requested effective date

What other change would you like to make?

Coverage amount and death benefit

Premium and payment options

Beneficiaries or policy ownership

Cash value and policy loans

Policy performance

Riders and living benefits

Term conversion or renewal options

Whether my coverage still meets my needs

Other

Briefly explain Other Policy Change

Required Acknowledgment *

I understand that submitting this request does no guarantee approval or change my insurance coverage. My request is not effective until confirmed by PillarVault Insurance or the insurance carrier.