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Date*
Time*—Please choose an option—00:00:0000:30:0001:00:0001:30:0002:00:0002:30:0003:00:0003:30:0004:00:0004:30:0005:00:0005:30:0006:00:0006:30:0007:00:0007:30:0008:00:0008:30:0009:00:0009:30:0010:00:0010:30:0011:00:0011:30:0012:00:0012:30:0013:00:0013:30:0014:00:0014:30:0015:00:0015:30:0016:00:0016:30:0017:00:0017:30:0018:00:0018:30:0019:00:0019:30:0020:00:0020:30:0021:00:0021:30:0022:00:0022:30:0023:00:0023:30:00
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Month123456789101112
Day12345678910111213141516171819202122232425262728293031
Year19251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025
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Month(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months
Length of Employment*
Year(s)1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 Years20 Years21 Years22 Years23 Years24 Years25 Years26 Years27 Years28 Years29 Years30 Years
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Relationship to Applicant*
1.0% TCS Applicable
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Comments*
AM/FM StereoAir conditioningAlloy WheelsCD Player/ChangerCassetteCruise ControlDVD PlayerLeatherNavigationPower LocksPower SeatsPower WindowsSatellite RadioSunroof
Year*
Make*
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Exterior Colour*
VIN*
Kilometres*
Engine*
Doors2345
TransmissionAutomaticManual
DrivetrainAWD2WD4WD
Body (dents, dings, rust, rot, damage)1234568910 Best
Tires (tread wear, mismatched)1234568910 Best
Engine (running condition, burns oil, knocking)1234568910 Best
Transmission/Clutch (slipping, hard shift, grinds)1234568910 Best
Glass (chips, cracks, pitted)1234568910 Best
Interior (rips, tears, burns, faded/worn)1234568910 Best
Exhaust (rusted, leaking, noisy)1234568910 Best
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Is the odometer operational and accurate?YesNo
Detailed service records available?YesNo
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Did you buy the vehicle new? work correctly?
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Has the vehicle ever had paint work performed?
Is the title designated 'Salvage' or 'Reconstructed'?
