MV1484

Unregistered Vehicles and Missing Signatures Declaration

CANADA PROVINCE OF BRITISH COLUMBIA TO WIT:

PLATE NUMBER REGISTRATION NUMBER

IN THE MATTER OF MODEL YEAR

MAKE/MODEL

VEHICLE IDENTIFICATION NUMBER (VIN)

I, NAME

OCCUPATION

of ADDRESS

In the Province of British Columbia, do solemnly declare that

I hereby agree to indemnify and save harmless the Insurance Corporation of British Columbia, its directors, officers, and employees and any person appointed to act as its agent or authorized in writing to act on its behalf, and the government of the Province of British Columbia, from any action, whether civil or criminal, that may arise as a result of processing this application for registration or transfer, and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the “Canada Evidence Act”.

Declared before me at In the Province of British Columbia, (date) APPLICANT

SIGNATURE

MV1484 (042015)

A Notary Public in and for the Province of British Columbia A Commissioner for Taking Affidavits for British Columbia A person authorized under Motor Vehicle Act section 66

STATUTORY DECLARATION CANADA EVIDENCE ACT Motor Vehicle Act, Off-Road Vehicle Act Reason: a) To allow the registration of an unregistered vehicle, b) To allow the transfer of a vehicle when the seller’s signature is missing, or c) To allow the registration of a vehicle when the purchaser does not have a registration document or acceptable proof of ownership. The declaration must include all of the following information: 1) The vehicle year, make, model, body style, and VIN, (may use “NIL” as a VIN for a ubilt trailer* with a Gross Vehicle Weight [GVW] of 1400 kg or less). 2) Seller’s name and, if applicable, details of the attempts made to obtain the seller’s signature. 3) Description of any documents available to establish ownership. 4) For a vehicle (other than a ubilt trailer), • Where and when the vehicle was purchased, the amount paid, and confirmation that the vehicle conforms to the original manufacturer’s specifications, does not contain parts from other vehicles, and is not missing an engine or any major body parts, such as a door or a fender. • If parts were replaced, include the names of the individuals or companies (e.g., retailers or auto wreckers) where the major components were purchased, and, if available, the VIN or serial number for all major components. OR

For a ubilt trailer, • Where and when the trailer was purchased, the amount paid, the names of the individuals or companies (e.g., retailers or auto wreckers) where the major components were purchased, and, if available, the VIN or serial number for all major components.

5) A statement whether or not the vehicle has ever been registered. 6) If the vehicle was purchased from a dealer or licensed auction sales company in Alberta or Saskatchewan include the following information: • The vehicle was purchased from a dealer or licensed auction sales company (as applicable) in Alberta or Saskatchewan (as applicable), • The purchaser(s) do not have the vehicle registration document, and • To the best of their knowledge, the purchaser(s) have proper ownership of the vehicle. Ask your Autoplan agent if there is any other information that is required for your particular circumstance. The declaration is a fill-in-the-blank form. In all cases, the declaration must be completed in full. The person giving the declaration must initial any changes to the form, including corrections. The declaration must be completed and sworn before either a notary public or commissioner for taking affidavits. This type of transaction requires basic legal knowledge. Therefore, if you are unfamiliar with this process, refer to a lawyer for advice. * Ubilt trailer refers to a trailer that does not have a National Safety Mark from Transport Canada and has been constructed by an individual or company. Although the builder may make more than one trailer that is similar, the trailer is unique to the builder.

MV1484 (042015)