This form is for consumers who are interested in making a claim for their vehicle. Based on a few questions, an assessment of whether some basic requirements are met to qualify.

It is important to have the following information on hand, to be able to fill out the application.

1. Current odometer reading
2. Vehicle Identification Number
3. Make and model year
4. File number and name of the person spoken to at the manufacturer, who had been trying to resolve the issue

Respond Yes or No to the qualification questions. In order to qualify the responses need to be inline with:

1. The age of the vehicle must be 2012, 2013, 2014, 2015, 2016, or 2017
2. Mileage must be under 160,000 km
3. The vehicle must not weigh more than 4,536 kg (10,000 lbs)
4. You must still own and/or lease the vehicle
5. You must have communicated the issue with the manufacturer and authorized dealer, to provide them with sufficient time to rectify the issue
6. You must not have attempted to resolve the issue in court

If a response during the qualification stage is such that the claim is ineligible a notification will pop up similar to this one. If you qualify, a larger application page will open automatically.

Using the information collection form, you will insert contact, vehicle, manufacturer and claim details to be reviewed.

1. Type in your Name
2. Provide a phone number, select add a new phone number for each number you would like to add If create a new phone number is not visible select and create a new phone number will appear.
3. Add an address using create an address it will auto-populate for you
4. Include your VIN number you can find it on your car registration/insurance/front dashboard by the window
5. Input your vehicles current odometer/mileage reading
6. Click the box if the vehicle has been used for business purposes. If it has, provide the business name and the percentage of time it was used for the business.
7. Include the file number(s) the manufacturer has provided you
8. Provide a brief description of the problem
9. Select the calendar icon and choose the date, the last time the vehicle was seen by a dealer
10. Use the delete button to remove any issues as required
11. Select add another problem for each issue you would like disclosed in the claim
12. Create a username and password to be able to access details of your claim