(Please type or MOTOR VEHICLE BILL OF SALE print legibly)

Blocks “A” and “B” MUST be completed in order to render this bill of sale acceptable for vehicle registration. Block “C” is optional. A This is to certify that I, the Seller, NAME Surname Given names Phone number ADDRESS Apt. No. Number & Street

City/Town/Community Province/Territory Postal Code IDENTIFICATION Type (eg. Driver Licence) Number

Do hereby sell my vehicle described as follows,

Manufacturer Year Model Plate number Odometer reading

Vehicle Identification Number (VIN) Body colour Roof colour TYPE OF VEHICLE - ENTER X ___ 2 Door Sedan ___ Motorhome ___ Farm Tractor ___ All-Terrain Vehicle ___ 4 Door Sedan ___ Sport Utility Vehicle ___ Hearse ___ Mini-auto ___ Convertible ___ Moped ___ Service Rig ___ Mini-bike (2 wheels) ___ Hatchback ___ Motorcycle ___ Truck ___ Motorcycle ___ Sportscar ___ Ambulance ___ Truck/Trailer ___ Snow Vehicle Combination ___ Stationwagon ___ Bus ___ Van ___ School Bus ___ Other Vehicle - Describe

TRAILER TYPE - ___ Commercial ___ Utility (Personal use) ___ Boat ___ Travel ___ Other ______

To the following buyer, NAME Surname Given names Phone number ADDRESS Apt. No. Number & Street

City/Town/Community Province/Territory Postal Code VEHICLE SOLD FOR THE SUM OF : (SUBJECT TO THE TERMS & CONDITIONS SPECIFIED IN BLOCK “C”) | $ B I hereby certify that the above information is true to the best of my knowledge and understanding. DATED THIS _____ DAY OF ______, 20______SELLER AT ______IN THE ______SELLER’S WITNESS PROVINCE/TERRITORY OF ______BUYER IN THE COUNTRY OF ______. ______BUYER’S WITNESS

C SPECIAL CONDITIONS OF SALE - The Vehicle described as above is: 1. Free of all liens and emcumbrances? □ Yes □ No If no, name of lien holder is: ______2. Paid in full? □ Yes □ No PAID BY - □ Cash □ Cheque □ Money Order □ Other ______3. Payment terms? □ Yes □ No If yes, specify: ______4. Where was the vehicle last registered? ______5. Special conditions of sale? □ Yes □ No If yes, specify: ______INFORMATION FOR A BUYER/SELLER OF A MOTOR VEHICLE

1. The law in the Northwest Territories requires that a vehicle be insured prior to registration. Documented proof of automobile insurance must be presented.

2. The Buyer can conduct a search for liens and encumbrances registered against the motor vehicle by accessing the lien check service (https:// pprs.acol.ca/lc/) of the Personal Property Registry. Lien Check is an online internet service that allows users to search by serial number. For further information, Buyers can contact the Legal Registries Division of the Department of Justice at (867) 873-7927.

3. This Bill of Sale form, properly completed, or a reasonable facsimile containing the exact same information, is required to register a change of ownership of a vehicle.

4. This form is provided as a courtesy by the Department of Infrastructure, Road Licensing & Safety Division, of the Government of the Northwest Territories, to ensure the required information is contained in the Bill of Sale to allow the new owner to register the vehicle. The Government of the Northwest Territories assumes no liability for the use of this document with regard to the sale of the described vehicle and any legal disputes arising therefrom.

5. Present a copy of this form at the time of registration.