Please complete the following questions:

	Yes	No
Is your employer a member in good standing of ONEIA?
Have any driver in your household had more than 2 minor convictions i.e.: speeding or any major convictions in the past 3 years?
Have you had continuous insurance for the past 6 years?
Have you had any accidents in the past 6 years that were deemed to be your fault?
Do you own your own  home, condominium or townhouse?

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Last modified: 08/15/05