I, __________________________________, of________________________________, Canada, hereby loan to

___________________________________of , ________________________________, my

vehicle registered in my name, stated below, for the period of ________ weeks from ________ to __________,

inclusive, and grant the above named person(s) permission to be a guest driver of my vehicle within this area:

__________________________. It is understood that the driver must be in possession of a valid Driver’s Licence.

In the event of an accident in which the above named persons are blameworthy, they hereby agree to reimburse the

vehicle owner, _________________, for the deductible portion of the insurance claim in the amount of $________

for collision. They also agree to reimburse the vehicle owner the full amount of any sum in excess of the owner’s

liability coverage should a legal suit for bodily injury and/or property damage result in an award in excess of the

owner’s insurance coverage. Furthermore, they hereby agree to reimburse the vehicle owner for the loss of his safe

driving discount each year for a period of ____ years, or, at the choice of ____________________________, pay

outright the total cost of any repairs required as a result of the accident.

Additional conditions: (e.g., emergency repair expenses) :

 _________________________________________________________________________________________

Make of Vehicle: Model/Year: Licence No.: _________________________________________________

Serial Number: Registration Number : ______________________________________________________

_________(Owner's Name)______________________    ____________(Owner's signature)______________________

 Current HomeLink International member number ________________________ Date _______________________

________(Ex. Partner's Name)____________________    ___________(Ex. Partner's Signature)_____________________

Current HomeLink International member number __________________________ Date ______________________