Prorate Fleet Application PRORATE ACCOUNT NO. FLEET NO. EFFECTIVE DATE (yyyymmdd) EXPIRY DATE (yyyymmdd) BC Requirements BC REGISTRANT NAME OPERATING AUTHORITY Mailing address: ICBC PO Box 7500 Stn Terminal Vancouver BC V6B 5R9 IFTA NO. Type of application PERSON TO CONTACT New fleet TELEPHONE ADDRESS Renew fleet FAX Private PROVINCE POSTAL CODE REGISTRANT CONTACT REGISTRANT TELEPHONE X JURISDICTION DISTANCE POSTAL CODE For hire Household goods Copy of current IFTA Licence is required for New and Renew transactions. EST PRORATE All distances must be in kilometres JURISDICTION DISTANCE EST PRORATE JURISDICTION DISTANCE EST PRORATE JURISDICTION (BC) British Columbia (CO) Colorado (MS) Mississippi (TN) Tennessee (AB) Alberta (CT) Connecticut (MO) Missouri (TX) Texas (SK) Saskatchewan (DE) Delaware (MT) Montana (UT) Utah (MB) Manitoba (DC) Dist. of Columbia (NE) Nebraska (VT) Vermont (ON) Ontario (FL) Florida (NV) Nevada (VA) Virginia (QC) Quebec (GA) Georgia (NH) New Hampshire (WA) Washington (NB) New Brunswick (ID) Idaho (NJ) New Jersey (WV) West Virginia (NS) Nova Scotia (IL) Illinois (NM) New Mexico (WI) Wisconsin (PE) Prince Edward Is. (IN) Indiana (NY) New York (WY) Wyoming (NF) Newfoundland (IA) Iowa (NC) North Carolina (YT) Yukon (KS) Kansas (ND) North Dakota (MX) Mexico Other ____________ (NT) Northwest Terr. (KY) Kentucky (OH) Ohio (LA) Louisiana (OK) Oklahoma (AL) Alabama (ME) Maine (OR) Oregon (AK) Alaska (MD) Maryland (PA) Pennsylvania (AZ) Arizona (MA) Massachusetts (RI) (AR) Arkansas (MI) Michigan (SC) South Carolina (CA) California (MN) Minnesota (SD) South Dakota Note: For fleets with a new or renewal effective date on or after January 1, 2015, full reciprocity in all jurisdictions is granted to each vehicle in the fleet. All jurisdictions will display on the cab card. If a fleet has actual distances, fees will be calculated for each jurisdiction that has an actual distance. If a fleet has no actual distances, the Average Per Vehicle Distance (APVD) Chart will automatically be applied and used to calculate fees. For fleets with a new or renewal effective date prior to January 1, 2015, actual distances or the BC Estimated Kilometer Chart will be used to calculate fees and only selected jurisdictions will display on the cab card. MV1510F (102014) Rental Check if using the BC Average Per Vehicle Distance (APVD) Chart (only applies if ﬂeet effective date is on or after January 1, 2015) Note: If using the BC APVD Chart, there is no requirement to enter the chart distances on this application. Check if using the BC Estimated KM Chart times the number of vehicles in the ﬂeet (only applies if ﬂeet effective date is prior to January 1, 2015) REGISTRANT FAX Distances listed below experienced from July 1, 20_____ to June 30, 20_____ . PRORATE PROVINCE CITY/TOWN Add jurisdiction (Add jurisdiction only applies if fleet effective date is prior to January 1, 2015) Type of operation MAILING ADDRESS CITY/TOWN Telephone: 604-443-4450 Toll Free in BC: 1-800-665-4336 Fax: 604-443-4451 Total actual distance Total estimated distance Total distance Rhode Island ICBC USE ONLY Declaration: I, the undersigned, declare that all requirements have been met for vehicle registration, for insurance and for the payment of all fees and taxes that may be required by statute or regulation of those jurisdictions in which travel is intended. I certify that the information contained in this application and supporting documentation is true and complete. I am fully aware of the requirements and obligations of the International Registration Plan (IRP) and understand that information contained on this application and supporting documentation may be shared with IRP member jurisdictions, IRP Inc., and the Ministry of Finance to ensure compliance with the IRP, the Motor Fuel Tax Act, the Provincial Sales Tax Act, the Commercial Transport Act, and other jurisdictions’ IRP-related requirements. REGISTRANT SIGNATURE PRINT NAME & TITLE DATE DISTANCE 0 EST