[PDF] Power of Attorney (Natural Person Only)

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Société de l"assurance automobile du Québec Page 1 of

4Original document in French

Information About How to Use the Power of Attorney (Natural Person Only)

Carefully read the information below before filling out the form.A power of attorney is an important document. You (the mandator) are giving the person of your choice (the mandatary) the power to

conduct on your behalf a transaction in connection with your record with the Société de l'assurance automobile du Québec (the SAAQ).

1 Y

ou must ?ll out, sign and date the power of attorney if you cannot go in person to the SAAQ and want to authorize another person

(the mandatary) to represent you. The person representing you (the mandatary) acts on your behalf.

In this form,

the following term s are defined as follows:

Mandator:

Person who gives another person the pow

er to represent them and conduct a transaction on their behalf with the SAAQ. M andatary: Person who agrees to represent you and conduct a transaction on your behalf with the SAAQ. T r ansferor:

Person who sells or gives away a vehicle.

A

cquirer: Person who becomes the owner of a vehicle (e.g. person who purchases, inherits or is given a vehicle).

1 See section 1 of the "Power of Attorney" form.

1) All of the necessary sections must be completed according to the instructions.

2) The power of attorney must not contain text that has been erased, crossed out or altered.

3) Signatures must be handwritten. (Electronic or scanned signatures will be refused.)

4) A fax or copy of a duly completed form can be accepted only if the required signatures are original.

5) The person representing you (the mandatary) must be age 18 or older and will have to provide one piece of identi?cation accepted

by the SAAQ. 2

6) If you have a valid Québec driver's licence and you indicate your Québec driver's licence reference number in Section 1 - Information

about the mandator, the person representing you (the mandatary) will not have to provide an original piece of identi?cation in your name.

If you choose to indicate only your date of birth in Section 1 - Information about the mandator, you must provide the person representing

you (the mandatary) with an original piece of identi?cation accepted by the SAAQ. 2

The person representing you (the mandatary)

must show your original piece of identi?cation to conduct the transaction on your behalf.

2 Original pieces of identi?cation accepted by the SAAQ:

-Licence authorizing the operation of a vehicle -Identity card issued by the SAAQ for a test -Certi?cate of Canadian citizenship with photo -Permanent Resident Card -Passport -Certi?cate of Indian Status card -Health Insurance Card -Authorized driver's permit -Peace officer's identity card -Canadian Armed Forces identity card

What is a power of attorney?

For the power of attorney to be accepted:

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4Original document in French

If you are selling or giving away your vehicle, complete and sign sections 1, 2 and 3A.

IMPORTANT! You could be held responsible for a traffic violation committed with the vehicle as long as it is registered under

your name

It is your responsibility to ensure that the vehicle is registered under the acquirer's name. If the person representing you

(the mandatary) does not transfer the ownership of the vehicle, you remain responsible for it. If you are acquiring a vehicle, complete and sign sections 1, 2 and 3B.

If the acquirer is absent, the mandatary will not be allowed to proceed with the transfer if the odometer reading reported in section 2 or 3B

is less than what was declared at the time of the previous vehicle registration. The acquirer can ask the transferor for explanations or go in

person t

o authorize the SAAQ to proceed with the transfer of ownership if the acquirer still wishes to do so.

Vehicle registered under two names (co-ownership or co-lease)

All co-owners or co-lessees must be present to transfer the vehicle. If one of them is absent, the other must provide a power of attorney

3 Giving away or selling a vehicle between related individuals: To give away or sell a vehicle registered in Québec between related individuals, both parties must present:

•the Declaration of a transaction between related individuals with regard to a road vehicle registered in Québec (VD-80.1-V), form from

Revenu Québec, duly completed;

•a document proving kinship. 3

To avoid unpleasant surprises

Before making the transfer, verify whether the vehicle can be registered by calling 1-900-565-1212 or using the

Checking if a Vehicle

Can be Registered

online service on the SAAQ's website at saaq.gouv.qc.ca . Fees are charged for each consultation.

3 For more information, or to ?nd out which documents are accepted to prove kinship, contact the SAAQ's call centre at 418-643-7620 in the Québec area, 514-873-7620 in

the Montréal area, or 1-800-361-7620 (Québec, Canada, United States), or consult the SAAQ's website (

saaq.gouv.qc.ca

Transferring ownership of a vehicle

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4Original document in French

Power of Attorney

(Natural Person Only) Information about the mandator (person who is being represented) Information about the mandatary (person of full age agreeing to represent the mandator)

Power of attorney

Section 1 - Information about the mandator, the mandatary and the power of attorney (Complete for each transaction.)

Last name

Last name

Mark

Québec driver's licence reference number

If you indicate your driver's licence reference number, the person representing you will not have to show your original piece of identi?cation to conduct the transaction.

Telephone number

First name

Québec driver's licence number

Licence plate numberYear

First name

Province

Province

Model Provide an official piece of identi?cation and indicate your date of birth (Year-Month-Day) If you do not indicate your driver's licence reference number, you must indicate your date of birth and provide the person representing you (mandatary) with an original piece of identi?cation accepted by the SAAQ.

Québec driver's licence number

Address

Address

OR

Street number

Street number

Street name

Street name

Municipality

Municipality

I authorize the person named above (mandatary) to act on my behalf concerning the following transaction:

Immatriculation

(Registration section 2.)

Vehicle storage or licensing for road use

Discarding a vehicle

Replacement of a registration certi?cate

Vehicle ownership transfer (Complete section 3.)

Other, specify:

Licence

Cancelling a driver's licence

Other, specify:

This power of attorney is valid until:

Don't forget to make sure that the person representing you (mandatary) can visit an SAAQ service outlet before the expir y date of this power of attorney.

I have signed

Postal code

Postal code

Apt. Apt.

À l'usage

de la Société

Numéro de la ou des plaques délivrées

ou NI de l'acquéreur Note : Please ?ll out the form using upper case letters with a black or dark blue pen. Mandator's signatureDate (Year-Month-Day)Place of signature (City)

Vehicle description

Section 2 - Information about the vehicle (Complete for all transactions in connection with a vehicle.)

The information requested in this section can be found on the vehicle's registration certi?cate (except for the odometer reading).

Vehicle identi?cation number

(VIN)Mileage (depending on odometer) kilometres miles Complete the next page if the transaction involves the transfer of ownership of a vehicle.

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4Original document in French

Protection of Personal Information

The SAAQ only collects personal information that is necessary for it to exercise its powers and apply the laws it administers. All personal information gathered by authorized personnel is handled con?dentially. This information may be shared with its licensing agents and certain government departments or agencies, including those located outside Québec, in accordance with the Act respecting Access to documents held by public bodies and the Protection of personal information. It may also be used for statistical, survey, study, audit or investigative purposes. Failure to provide this information can result in a refusal of service. You may consult, correct or obtain a copy of any personal information concerning you.

For more information, consult the Policy on Privacy on the SAAQ's website at saaq.gouv.qc.ca/privacy or contact the SAAQ's call centre.

In the case of a transfer of ownership, ?ll out

one of the following sections:

• Section 3A: If you are being represented (mandator) for the transfer of a vehicle and you are selling or giving away the vehicle (transferor);

OR

• Section 3B: If you are being represented (mandator) for the transfer of a vehicle and you are acquiring a vehicle.

À l'usage

de la Société

Numéro de la ou des plaques délivrées

ou NI de l'acquéreur Declaration of the transferor being represented (mandator) Section 3A - Declaration of transfer (Complete if you are selling or giving away a vehicle.) I declare that I have sold my vehicle for the sum of $

I declare that I have given my vehicle away.

New owner's name (print)

Transferor's signature

Declaration of the acquirer being represented (mandator) Section 3B - Declaration of transfer (Complete if you are acquiring a vehicle.)

I declare that the odometer reading is

kilometres miles

Acquirer's signature

OU

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