Government of Ontario: Ministry of Transportation

Low-Speed Vehicle (LSV) Registration Declaration

Note:
This is the text only version of the Declaration form. It is simplified for use with assitive devices only. If you are able to use other versions such as PDF and MSWord, you are encouraged to download and complete the version available from the main forms site.

Office Use Only / À l'usage du bureau

Office No. Operator No.

Manufacturer/ Seller Information

Name
Address
Postal Code

Note: A low-speed vehicle manufacturer or seller must provide the buyer or lessee with this document stating that he/she has read and understood the conditions listed below prior to purchase or leasing the LSV.

This LSV has a compliance label bearing the notation (please check one):

ONT-LSV-BASIC ONT-LSV-5CMVSS

Make Model Year
VIN

Applicant Information

Last Name, First Name, Middle Name or Company Name
Street No. and Name or Lot, Con. and Twp
Apt. No.
City, Town or Village
Postal Code
Registrant Identification No. (Driver’s Licence No.)

I have read and understood the safety and operating conditions listed below.

Safety and Operating Conditions

LSVs are not equipped with safety features customarily found in passenger vehicles.
A fully licensed driver (A, B, C, D, E, F or G) may operate an LSV on Ontario roads with a posted speed limit up to a maximum of 50 km/h on:
- Pelee Island, within university/college campuses, and to cross directly between private properties if the LSV’s compliance label bears the notation “ONT-LSV-BASIC” or “ONT-LSV-5CMVSS”, or;
- Province-wide if the LSV’s compliance label bears the notation “ONT-LSV-5CMVSS”
- A traffic control device must be present before a low-speed vehicle may directly cross a higher speed road with a speed limit greater than 50 km/h and up to 80 km/h (LSVs travelling between private properties may directly cross a higher speed road up to 60 km/h without a traffic control device).
The buyer or lessee is responsible for confirming the vehicle’s safety features with the manufacturer/seller before proceeding with any purchase, lease, or rental.
The use of LSVs on public roads may not be permitted after December 31, 2014.
LSVs must display a slow moving vehicle sign.
LSVs must be registered and plated to operate on Ontario’s roads. Drivers and passengers must obey all pertinent laws.
LSV operators must have the same insurance coverage as for a regular passenger vehicle.
It is an offence to:
- carry any combustible fuel on or in the vehicle.
- carry a passenger under eight years of age.
- carry more occupants than the number of seating positions in the vehicle, or more than 4 occupants, whichever is less.
- modify the vehicle to reach a maximum driving speed faster than 40 km/h.
- tow another vehicle or device.

Signature of Applicant
Date (yyyy/mm/dd)

Note: It is the responsibility of the LSV owner/operator to ensure adherence to all LSV Pilot Program Safety and Operating conditions and the requirements of the Highway Traffic Act. Please retain a copy of this form for your records before submitting.

Information in this form is collected under the authority of the Highway Traffic Act. If you have any questions about the collection and use of your personal information collected on this form, please call the Supervisor, ServiceOntario at 416 235-2999 or 1 800 387-3445 or write to the Supervisor, Ministry of Transportation, Licensing Administration Office, Main Floor, Building A, 1201 Wilson Avenue, Downsview, Ontario, M3M 1J8. Direct general inquiries to ServiceOntario 416 235-2999 or 1 800 387-3445 or visit www.ServiceOntario.ca.