Auto Quotes, Requests and Other Forms | Report a Claim | Payments | FAQs | Links | Policy Downloads | Request Information Evidence of Automobile Insurance Request Form Upon completion of the below form, A.J. Pijar Insurance will issue an Evidence of Insurance immediately. You, the insured, will receive a "Cc" copy. You are welcome to contact us with any questions. Thank you for your request. Please NOTE: The * noted fields are required in order to submit this form. * Your Name: * Your Phone: Your Fax (if applicable): * Your E-Mail: Please complete the following to issue proof of Automobile Insurance. Automobile Information: Year/Make/Model Plate (Registration) Number: Name of Lien Holder: Address: City, State, Zip: Attention: Phone Number: Fax Number: Loan Number: Please click the "SEND" button only once.