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AARP® Property and Casualty Insurance Program from Real Legacy Assurance US Virgin Islands personal automobile application


Enter your first, middle and last name.
Remember to inlcude your zip code
Enter your email address where you want to receive important information from us.
This is optional but it helps us in our statistics and customer service.

Do you have a (Homeowner's or Dwelling) policy from/through the AARP® Property and Casualty Program from Real Legacy Assurance?

If yes selected in the previous question, provide the policy number.

Secction 1: Coverages



Section 2: Liability Limits


Note: If you have selected the Combined Single Limit option above, please do not select any other option below except Medical Payments if you wish to include that coverage.
Select one if you wish this coverage.
If you selected the check mark above, you do not select any of these options.

Secction 3: Description of automobiles


You need to insure at least one automobile.

Automobile #1

Required if you wish to cover damage to your auto
Required if you wish to cover damage to your auto

Automobile #2

Required if you wish to cover damage to your auto
Required if you wish to cover damage to your auto

Automobile #3

Required if you wish to cover damage to your auto
Required if you wish to cover damage to your auto

Secction 4: Driver information


Important! The company will be within its rights to decline any claim arising out of the use of the vehicle whose driver is under age 25 and not declared on this application. Remember to enter the applicant's information in driver #1 section.


You need to include at least one driver.

Driver #1

Type the full name of the driver.
Type your license numbers only.
Select how much time you spend using the auto.

Driver #2

Type the full name of the driver.
Type your license number
Select how much time you spend using the auto.

Driver #3

Type the full name of the driver.
Type your license number
Select how much time you spend using the auto.


Secction 5: Notification disclaimer


Important notice regarding the fair credit reporting act: In this application for insurance it is understood that as a part of our underwriting procedure, an investigative consumer report may be prepared whereby information is obtained through personal interviews with your neighbors , friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics and mode of living. If an investigation is made you can be assured it will be handled in the strictest confidence. If you wish information on the nature and scope of the customer report which may be requested, ask your agent for the address of the company handling your account.