MVA- Information Sheet.doc 2026

1. Click ‘Get Form’ to open the MVA- Information Sheet.doc in our editor.
2. Begin by filling out the 'Auto Insurance Information' section. Enter your insurance company name, address, adjuster's name (last and first), phone number, and fax number.
3. Next, provide the name of the insured (last and first), policy number, date of loss/accident (D.O.L), and claim number.
4. Proceed to the 'Extended Health Insurance Information' section. Fill in your employer's name, private insurance company details, policy/group number, and certificate/ID number.
5. Indicate your physiotherapy and massage coverage amounts per year and whether a referral is required for each service.
6. If applicable, answer whether your spouse has private health insurance. If yes, complete the spouse's extended health insurance information as instructed.

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