CARRIER ACCOUNT NUMBER ON FLEET # SUPPLEMENT # EFFECTIVE DATE EXPIRY DATE FLEET RIN REG YEAR CARRIER'S NAME (FULL LEGAL NAME) OPERATING AS (IF APPLICABLE) DEFERRED PAYMENT? Yes = Y No = N BUSINESS NUMBER (BN)
PERSON TO CONTACT MAILING ADDRESS TELEPHONE FAX E-MAIL ADDRESS
ON BUSINESS ADDRESS (PHYSICAL LOCATION) MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CVOR NUMBER FUEL TAX NUMBER (IFTA)
Private (P) Daily Rental (R) For-Hire (H) Household Goods (M)
New Fleet (NF) Renewal Fleet (RF) Amend Fleet (AF) Replace Plate (RP) Add Jurisdiction (AJ) Delete Fleet (DF) Change Weight (CW) Repl. Cab Card (RC)
APPLIED YES No
Compulsory Automobile Insurance Act (for use only where the applicant has registered or is registering under the International Registration Plan (IRP))
I hereby certify that the motor vehicle(s) listed on this application is (are) insured under a contract of automobile insurance made with the insurance company (companies) shown:
NAME OF INSURANCE CO. POLICY # IRP FLEET # INSURANCE EXPIRY DATE NAME OF IRP REGISTRANT SIGNATURE DATE
I, the undersigned, declare that all requirements for vehicle registration, for insurance and for the payment of all fees and taxes may be required by statute or regulation of those jurisdictions in which travel is intended have been met. I hereby certify that the information furnished in this application and supporting documentation is true and complete. I am fully aware of the requirements and obligations imposed by the International Registration Plan and understand that information contained on these forms may be shared with IRP member jurisdictions, the IRP Clearinghouse and the Ministry of Finance to ensure compliance with the Plan, the Fuel Tax Act, the Gasoline Tax Act, the Retail Sales Tax Act and other jurisdictions' IRP-related requirements. I have obtained consent from each vehicle owner or lessee to provide their respective vehicle information that appears on Form 4, and I have informed each vehicle owner or lessee of the purposes for the collection, uses and disclosures, as indicated above . I maintain an established place of business as required by the International Registration Plan. Information provided in the application form is collected under the authority of regulation 11/04 under the Highway Traffic Act and is used for the purpose of administering the International Registration Plan program. For further information please contact the Group Leader - IRP Program Office, 1201 Wilson Avenue, Building C, Room 143, (416) 235-3923 or toll free 1-866-587-6770 for any questions regarding the collection of information.
Authorized Signature Date City / Town Province / State
Office Number Operator Number Business Date
Link to Form 2
Link to Form 3
Link to Form 4 (Truck/Trailer)
Link to Form 4 (Bus)