KBS Insurance Application
Driver Information Sheet for: ______________________

Driver Type
O / F*

Driver Name

Date of Birth

License#

State of Lic.

Date of Hire

Type of Vehicle**
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             

* Driver Type:                    ** Vehicle Type:    PP = Private Passenger
   O = owner-operator                          VN = Cargo Van       PU = Pickup       SUV = Sport Util.
   F = company fleet driver                   MV = Minivan     TK = Truck (box/bobtail...)   TT = Tract-Trlr.

Fax to KBS: 914-636-0802