Insurance Bureau of Canada
Suite 400, 370, 5222-130 Ave. SE
Calgary, Alberta
T2Z 0G4
Tel: (403) 258-3677
Fax: (403) 255-9054
Toll Free: 1-866-263-6240
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Application for an Alberta Assigned Vehicle Identification Number (VIN)

* Required Fields Important Information and Instructions
Owner
* Company Name
OR
* Name of Owner – Last * Name of Owner – First Name of Owner – Middle

* Address Apt * City/Town Province * Postal Code

Operator’s Licence Number
* Home Telephone Number Additional Telephone Number Email
Vehicle/Trailer Information
Your request will not be processed without this information
* Year Make Model * Colour Vehicle Style
Licence Plate Number (if available) Original VIN (if available)
Is this a Home Built Trailer
Vehicle/Trailer Location
Same as Mailing Address
If not, please specify the Vehicle/Trailer location
Address City/Town Province Postal Code
Reasons for the Assigned VIN Application



Other - Specify
Components
Only complete this section if the vehicle is home-built, ubilt, amalgamated, rebuilt, or contains major components that are not from the original vehicle.
Present the original invoices to IBC at the time of the vehicle / trailer examination. IBC will make copies or take digital pictures of the invoices for retention.
Component Name Name of Supplier Purchase Date (mm/dd/yyyy) Source Vehicle VIN
Engine
Transmission
Cab (Truck)
Dash Board
Chassis Frame
Payment
If paying by certified cheque or money order, please make cheque payable to “Insurance Bureau of Canada”. Payment must be sent at the time of application.
Examiners cannot collect payments.
* Payment Amount

* Mode of Payment
Credit Card Details
Expiry Date Credit Card Number Security Code

By submitting this form, I certify the above information is true.

Important Note: Only submit this form/transaction once. If an email is not received to indicate transaction completion, please contact 403-258-3677 or 1-866-263-6240 (toll free) to check the status of your submission.

This information is being collected for the purposes of motor vehicle administration in accordance with the Traffic Safety Act. The Freedom of Information and Protection of Privacy Act, s. 33 (c) governs Alberta Transportation’s collection of this information. Please direct question about the collection and use of this information to Alberta Assigned VIN Program, Alberta Transportation, Main Floor, Twin Atria Building, 4999 – 98 Avenue, Edmonton, Alberta T6B 2X3. Phone: 1-866-263-6240
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Please enter all required fields and/or correct all invalid entries.
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