RESUME OF HIGH-PERFORMANCE DRIVING EXPERIENCE

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RESUME OF HIGH-PERFORMANCE DRIVING EXPERIENCE
Please complete all sections

Name

Drivers License Number

State

Date of Birth

Occupation

Years of high-performance automobile ownership/operation

Prior high-performance autos you have OWNED / LEASED / FINANCED

Year/Make/Model

Engine size/HP

Years of experience

Dates operated

(from year to year)

Annual Miles Driven

Prior high-performance autos you have OPERATED BUT NOT OWNED

Year/Make/Model

Engine size/HP

Years of experience

Dates operated

(from year to year)

Annual Miles Driven

List all hobby related clubs, events participated in, licenses, driving courses, driving education classes, and/or racing experience. (if none, write "none"):

I HEREBY AFFIRM THAT ALL STATEMENTS MADE HEREIN HAVE BEEN ANSWERED TO THE BEST OF MY ABILITY AND ARE TRUE. I UNDERSTAND THAT THE UNDERWRITING COMPANY IS RELYING ON THIS DOCUMENT IN THE UNDERWRITING OF THE POLICY.