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.

• Current odometer reading
• Vehicle Identification Number
• Make and model year
• 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 in-line with:

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

• Type in your Name
• Type in your phone number and select the type of number it is

• Select add a new phone number for each contact number you would like to provide
• Provide an address by starting to type in the address box. The address will auto-populate for you

• Check your car registration/insurance/front dashboard by the window to provide your VIN number. Your VIN number will be checked for accuracy/validity

• Input your vehicles current odometer/mileage reading

• Choose yes or no in the box to indicate whether 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. Please only include numbers no symbols

• Include the file number(s) the manufacturer has provided you

• Provide a brief description of the problem

• Select the calendar icon and choose the date, the last time the vehicle was seen by a dealer

• If the issue is still outstanding, meaning it has not been fixed, select the box to place a check mark in it. If the issue has been resolved, however you are trying to get funds for expenses leave the box unchecked.

• Use the delete button to remove any issues as required
• Select add another problem for each issue you would like disclosed in the claim

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• Create a username and password to be able to access details of your claim

• Review all details for accuracy
• Submit Application

You will receive confirmation that qualification worksheet has been submitted and will be handled by a provincial administrator.