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)

as of Sept 1/16 there will be a price increase
* Required Fields Important Information and Instructions
* Company Name
* 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 If "Yes", what is the gross vehicle weight of the home-built Trailer? (kg)
Vehicle/Trailer Location
Same as Mailing Address
If not, please specify the Vehicle location
Address City/Town Province Postal Code
Reasons for the Assigned VIN Application

Other - Specify
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
Cab (Truck)
Dash Board
Chassis Frame
Make Certified Cheque/Money Order payable to "Insurance Bureau of Canada"
* 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 collected for the administration of the Alberta Assigned VIN program under the Traffic Safety Act. Contact Vehicle Safety and Carrier Services Branch, Main Floor, 4999-98 Avenue, Edmonton, AB, T6B 2X3, 780-427-8901 for questions about the collection of this information.
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