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Get Alberta Automobile Insurance Motor Vehicle Inspection Report 2005

The Alberta Superintendent of Insurance has approved this form pursuant to section 803 of the Insurance Act. AUTOMOBILE INSURANCE MOTOR VEHICLE INSPECTION REPORT This Report is required only if the vehicle is 12 years or older and must be completed by a licensed mechanic. Applicant/Insured Name Policy Number VIN Vehicle Make Vehicle Model Vehicle Year This Section to be completed by a Licensed Mechanic Roadworthy Reject Steering Steering Box/Rack Electrical System Head Lamp/Tail Lamps Struts/Shocks Front Suspension Tie Rod Ends Tires Front Rear Brakes Front Lining or Drums Rear Lining or Drums Park Stop Lamps Signal Lamps Windshield Wipers General Conditions Body Condition Muffler/Exhaust Motor Windshield Seat Belts Has the vehicle been altered for speed or performance Brake Hoses Brake Lines Is the vehicle roadworthy YES NO Mechanic s Statement I certify that I have inspected and tested the motor vehicle described above and found it to be in the condition stated above. The Alberta Superintendent of Insurance has approved this form pursuant to section 803 of the Insurance Act. AUTOMOBILE INSURANCE MOTOR VEHICLE INSPECTION REPORT This Report is required only if the vehicle is 12 years or older and must be completed by a licensed mechanic* Applicant/Insured Name Policy Number VIN Vehicle Make Vehicle Model Vehicle Year This Section to be completed by a Licensed Mechanic Roadworthy Reject Steering Steering Box/Rack Electrical System Head Lamp/Tail Lamps Struts/Shocks Front Suspension Tie Rod Ends Tires Front Rear Brakes Front Lining or Drums Rear Lining or Drums Park Stop Lamps Signal Lamps Windshield Wipers General Conditions Body Condition Muffler/Exhaust Motor Windshield Seat Belts Has the vehicle been altered for speed or performance Brake Hoses Brake Lines Is the vehicle roadworthy YES NO Mechanic s Statement I certify that I have inspected and tested the motor vehicle described above and found it to be in the condition stated above. Date Signature of Qualified Mechanic Mechanic s Certificate No* Automotive Repair Shop Name Address Telephone Number 06/2005. AUTOMOBILE INSURANCE MOTOR VEHICLE INSPECTION REPORT This Report is required only if the vehicle is 12 years or older and must be completed by a licensed mechanic* Applicant/Insured Name Policy Number VIN Vehicle Make Vehicle Model Vehicle Year This Section to be completed by a Licensed Mechanic Roadworthy Reject Steering Steering Box/Rack Electrical System Head Lamp/Tail Lamps Struts/Shocks Front Suspension Tie Rod Ends Tires Front Rear Brakes Front Lining or Drums Rear Lining or Drums Park Stop Lamps Signal Lamps Windshield Wipers General Conditions Body Condition Muffler/Exhaust Motor Windshield Seat Belts Has the vehicle been altered for speed or performance Brake Hoses Brake Lines Is the vehicle roadworthy YES NO Mechanic s Statement I certify that I have inspected and tested the motor vehicle described above and found it to be in the condition stated above. Date Signature of Qualified Mechanic Mechanic s Certificate No* Automotive Repair Shop Name Address Telephone Number 06/2005. .

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