I certify that I am the holder of a valid
North American driver's licence.
I certify that I have valid automobile insurance and
I understand that, to the extent that my insurance policy
includes the endorsement Q.E.F no. 27, the registered owner's
insurer or the MIAS may seek redress
from my insurer.
I agree to assume the deductible established in my insurance
policy in an amount equal to the proportion of any damage
caused to the test drive vehicle for which I am responsible
in relation to all damage incurred by this vehicle,
multiplied by the deductible.
I certify that, as of this date
(Dec. 15, 2019),
I am 25 years of age or older.
I certify that the persons (children) accompanying me
are at least 145 cm tall or at least 9 years old and therefore
do not require the use of a booster seat in accordance
with Section 397 of the Quebec Highway Safety Code.
I agree to assume full responsibility for any persons
accompanying me during the test drive and to ensure
that any children present are seated in a manner
that complies with Quebec legislation concerning motor
I respect current Quebec legislation
concerning legal blood alcohol levels.
During the test drive, I agree to uphold current seat belt laws for
myself as well as any persons accompanying me
in the vehicle.
During the test drive, I agree to comply with all Quebec
legislation governing the use of a motorized
During the test drive, I agree to drive in a safe
manner and to avoid creating dangerous
situations for myself, other passengers in the
vehicle and other drivers on the road.
I agree to assume all the costs of any traffic ticket
received as a result of my driving.
I agree not to use a radar warning device.
I agree to follow any instructions and directions given to me
by the instructor accompanying me during
the test drive.
I agree to report any and all incidents and/or damage
to the vehicle resulting from my driving.
By confirming below, I attest that, in the past 36 months,
I have not been convicted of any of the following
violations of Canadian legislation governing the
operation of a motorized vehicle:
Driving with a suspended, revoked or
cancelled driver's licence.
Dangerous driving causing
injury or death.
Driving while impaired by alcohol
or illegal drugs or refusal to submit
to a sobriety test by providing a blood
Fleeing the scene of an accident caused by
my driving and resulting in injury or death,
failing to report an accident caused by my
driving, or submitting false statements
to an officer of the law regarding an
Obstructing the work of an officer or obstruction of justice.
Any violation of traffic regulations
resulting in serious injury or death.
Any other violation of traffic regulations
resulting in the suspension or cancellation
(permanent or temporary) of a driver's