Letter Of Authorization For Temporary Operation Permit printable pdf download

Letter of Authorization for Temporary Operation Permit

To be completed by registered owner of vehicle

This Letter of Authorization permits __________________________________________________________ at

PRINT NAME OF THE PERSON OR COMPANY TO WHOM AUTHORIZATION IS GIVEN

_____________________________________________________________________________________________

PRINT ADDRESS OF PERSON OR COMPANY TO WHOM AUTHORIZATION IS GIVEN

to purchase an ICBC Temporary Operation Permit (TOP) for the following vehicle:

Model Year: __________ Make: ___________________ Model : _________________

VIN: ___________________________________________________________________

BC Registration #: _____________________ For Number of Days: _________ (MAXIMUM 15)

Commercial Vehicle only: □ Laden □ Unladen

Coverage (check all required):

□

BASIC $1,000,000 Third Party Liability coverage

□

Optional $5,000,000 Third Party Liability coverage (includes Basic)

□

Own Damage Coverage (Coll/Comp)

□

Replacement Cost (if applicable)

□

Limited Depreciation (if applicable)

Name and address of company or individual granting authorization

Owner Name: _______________________________________________________________ ________________

DRIVER’S LICENCE NUMBER

PRINT NAME(S) OF THE REGISTERED OWNER OF THE VEHICLE

Owner 2 Name (if applicable): _________________________________________________ ________________

IF TWO OWNERS, PRINT NAME OF THE SECOND REGISTERED OWNER OF THE VEHICLE

DRIVER’S LICENCE NUMBER

Address: _____________________________________________________________________________________

ADDRESS OF THE REGISTERED OWNER(S)

Date: __________________________ Signature: ____________________________________________________

IF SIGNING ON BEHALF OF A COMPANY, NOTE POSITION OR TITLE

Signature of Owner 2 (if applicable): ____________________________________________________

IF SIGNING ON BEHALF OF A COMPANY, NOTE POSITION OR TITLE

This Letter of Authorization is provided as a courtesy. Use of this Authorization is at your own risk and is

not mandatory. You may use this form, or create your own, using this as a guideline.

MV1803 (072012)

Letter Of Authorization For Temporary Operation Permit