Form Ca-1001-V - Registration Application For Indians Page 2

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CA -1001-V
2012 -05
2 of 2
2
Information about vehicles used and fuel consumption
Enter the licence plate number of each vehicle you use (optional). If you need more space, attach a sheet containing the requested information.
12
A
B
C
D
E
F
G
H
What is your estimated annual fuel consumption? ..................................................................................
13
litres
If you are an individual in business, do you use a vehicle for business? ......................................................
Yes
No
14
If yes, briefly describe your business activities.
15
3
Certification
I certify that the information on this form is, to the best of my knowledge, accurate and complete. Enclosed is a copy of both sides of my
Certificate of Indian Status.
16
17
Area code
Telephone
(home)
Area code Telephone (work)
Extension
Signature
Date
Print
1 0V D ZZ 494 88668

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