Application For Motor Vehicle Dealer'S License Form - Nova Scotia Page 2

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Is applicant a qualified Motor Mechanic? _____________ Is a qualified Mechanic employed? _______________ or by Agreement ________________

(As defined by the regulations)

(a)

If applying for a New Vehicle Dealers License state the name and address of two mechanics. For Used Vehicle Dealer state name and address

of one mechanic.

(i)

Name, address _________________________________________________________ Mechanics License # _____________________________

(ii)

Name, address _________________________________________________________ Mechanics License # _____________________________

(b) If mechanic is by agreement, signed agreement by mechanic must accompany application, indicating mechanic is available during the dealers

normal business hours at the principal place of business.

Is applicant an authorized dealer of a manufacturer or a sub-dealer? ____________________________________________________________________

(a)

Name and address of manufacturer ____________________________________________________________________________________________

(Attach certificate of franchise signed by manufacturer)

(b) Make of Vehicle ______________________________________________________________________________________________________________

(c)

In the case of a sub-dealer, state dealer represented ______________________________________________________________________________

(Attach certificate of appointment signed by dealer)

Has the applicant applied for or been issued a Dealer’s License within the past five years? ________

If answer to the above is ‘YES’ where was license held? _______________________________________________________________________________

Name of Dealership _______________________________________________________________________________________________________________

10. Which Finance Companies has applicant done business with during the last five years, give names, addresses and dates _____________________

________________________________________________________________________________________________________________________________

11. Have you more than one place of business in the county for which the license is applied for? __ If so, a supplemental license is required for each.

State number required _________________________Locations __________________________________________________________________________

How many cars can be displayed outside at each supplemental location? _______________________________________________________________

12. I hereby apply for the following:

New (Cars, Trucks, Truck Tractors, Motor Homes) License ................................................................................................................. $_____________

Used (Cars, Trucks, Truck Tractors, Motor Homes) License ............................................................................................................... $_____________

Sub Dealer (Cars, Trucks, Truck Tractors, Motor Homes, etc.) License .............................................................................................. $_____________

Farm Equipment (Tractors and Related Machinery, etc.) License ....................................................................................................... $_____________

Miscellaneous Equipment (Heavy Road Machinery, etc.) License ...................................................................................................... $_____________

Motorcycle and/or Motor Driven Cycle License .................................................................................................................................. $_____________

Trailer (Recreational Vehicles) License ................................................................................................................................................. $_____________

Trailer (Commercial) License ................................................................................................................................................................ $_____________

Supplemental License ......................................................................................................................................................................... $_____________

County License .................................................................................................................................................................................... $_____________

State the Counties for which County Licenses are required.

All Counties Licence (includes all seventeen Counties) ....................................................................................................................... $_____________

Motorcycle and Motor Driven Cycle Plates ......................................................................................................................................... $_____________

Dealers Number Plates ........................................................................................................................................................................ $_____________

Books of Temporary Permit Numbers ................................................................................................................................................. $_____________

Amount ................................................................................................................................................................................................ $_____________

Initial Automotive Dealer Application Processing Fee (non-refundable) .............................................................................................. $_____________

TOTAL AMOUNT REMITTED ............................................................................................................................................................... $_____________

I, the undersigned, do solemnly declare that the above statements and answers to the questions are true.

Signed, and declared before me at ________________________________________________

in the County of _________________________________________________________________

_____________________________________________

Applicant Sign Here

on the ___________day of ______________________________20 _________

________________________________________________________________

A Barrister or Commissioner of the Supreme Court of Nova Scotia