- All elements are data fields unless otherwise stated.
- Text' elements must useText' elements must use the exact words and be printed with every certificate.
- Elements may be omitted or added but an explanation must be provided.
- Elements do not have to be used in the same sequence and have been grouped for organizational purposes only.
Element 1. (Text) Certificate of Automobile Insurance (Ontario)
Element 2. Insurer
Element 3. (Text) This is your Certificate of Automobile Insurance. Contact your Broker/Agent with any questions or if you require clarification regarding your coverage choices.
Element 4. Policy Number
Element 5. Policy Effective Date (year/month/day)
Element 6. Policy Expiry Date (year/month/day), 12:01 a.m.
Element 7. (Text) All times are local times at the Named Insured's primary address shown on this Certificate.
Element 8. Date prepared
Element 9. Broker/Agent, including address, postal code and telephone number
Element 10. Named Insured, including primary address and postal code
Element 11. Lessor (if applicable), including address and postal code
Element 12. (Text) Described Automobiles
Element 13. Automobile Number
Element 14. Model Year and Make
Element 15. Model and Body Type
Element 16. Serial No./V.I.N.
Element 17. Cylinders/C.C.
Element 18. Purchase Price/List Price New
Element 19. (Text) Insurance Coverages
Element 20. Automobile Number
Element 21. (Text) Liability
Element 22. Liability Limit
Element 23. (Text) Bodily Injury
Element 24. Bodily Injury Premium
Element 25. Bodily Injury Premium for Occasional Driver
Element 26. (Text)Property Damage
Element 27. Property Damage Premium
Element 28. Property Damage Premium for Occasional Driver
Element 29. (Text) Accident Benefits (Standard Benefits)
Element 30. Accident Benefits Limit - (Text) As stated in Section 4 of Policy
Element 31. Accident Benefits Premium
Element 32. Accident Benefits Premium for Occasional Driver
Element 33. (Text) Optional Increased Accident Benefits
Element 34. (Text) Income Replacement ($600/$800/$1,000)
Element 35. Income Replacement Limit (Text) (up to $ per week)
Element 36. Income Replacement Premium
Element 37. Income Replacement Premium for Occasional Driver
Element 38. (Text) Medical, Rehabilitation & Attendant Care ($130,000/ $1,000,000)
Element 39. Medical, Rehabilitation & Attendant Care Limit
Element 40. Medical, Rehabilitation & Attendant Care Premium
Element 41. Medical, Rehabilitation & Attendant Care Premium for Occasional Driver
Element 42. (Text) Optional Catastrophic Impairment (additional $1,000,000 added to Standard Benefit or Optional Medical, Rehabilitation & Attendant Care Benefit)
Element 43. Optional Catastrophic Impairment Limit (Text) As stated in Section 4 of Policy
Element 44. Optional Catastrophic Impairment Premium
Element 45. Optional Catastrophic Impairment Premium for Occasional Driver
Element 46. (Text) Caregiver, Housekeeping & Home Maintenance
Element 47. Caregiver, Housekeeping & Home Maintenance Limit (Text) As stated in Section 4 of Policy
Element 48. Caregiver, Housekeeping & Home Maintenance Premium
Element 49. Caregiver, Housekeeping & Home Maintenance Premium for Occasional Driver
Element 50. (Text) Death & Funeral
Element 51. Death & Funeral Limit (Text) As stated in Section 4 of Policy
Element 52. Death & Funeral Premium
Element 53. Death & Funeral Premium for Occasional Driver
Element 54. (Text) Dependant Care
Element 55. Dependant Care Limit (Text) As stated in Section 4 of Policy
Element 56. Dependant Care Premium
Element 57. Dependant Care Premium for Occasional Driver
Element 58. (Text) Indexation Benefit (Consumer Price Index)
Element 59. Indexation Benefit Limit (Text) As stated in Section 4 of Policy
Element 60. Indexation Benefit Premium
Element 61. Indexation Benefit Premium for Occasional Driver
Element 62. (Text) Uninsured Automobile
Element 63. Uninsured Automobile Limit (Text) As stated in Section 5 of Policy
Element 64. Uninsured Automobile Premium
Element 65. Uninsured Automobile Premium for Occasional Driver
Element 66. (Text) Direct Compensation - Property Damage*
Element 67. (Text) *This policy contains a partial payment of recovery clause for property damage if a deductible is specified for direct compensation-property damage.
Element 68. Direct Compensation - Property Damage Deductible
Element 69. Direct Compensation - Property Damage Premium
Element 70. Direct Compensation - Property Damage Premium for Occasional Driver
Element 71. (Text) Loss or Damage**
Element 72. (Text) ** This policy contains a partial payment of loss clause.
Element 73. (Text) A deductible applies for each claim except as stated in your policy.
Element 74. (Text) Specified Perils (excluding Collision or Upset)
Element 75. Specified Perils Deductible
Element 76. Specified Perils Premium
Element 77. Specified Perils Premium for Occasional Driver
Element 78. (Text) Comprehensive (excluding Collision or Upset)
Element 79. Comprehensive Deductible
Element 80. Comprehensive Premium
Element 81. Comprehensive Premium for Occasional Driver
Element 82. (Text) Collision or Upset
Element 83. Collision or Upset Deductible
Element 84. Collision or Upset Premium
Element 85. Collision or Upset Premium for Occasional Driver
Element 86. (Text) All Perils
Element 87. All Perils Deductible
Element 88. All Perils Premium
Element 89. All Perils Premium for Occasional Driver
Element 90. (Text) Policy Change Forms
Element 91. Name and Number of Policy Change Forms, including limit if applicable
Element 92. Policy Change Premium
Element 93. Premium Subtotals
Element 94. Occasional driver subtotals
Element 95. Total Premium for each Automobile
Element 96. *Premium Subtotal + Occasional driver subtotal
Element 97. Total Policy Premium
Element 98: (Total Premium for Automobile 1 + Total Premium for Automobile 2)
Element 99. Tax
Element 100. Total Policy Cost
Element 101. Minimum Non-Refundable Premium
Element 102. (Text) Rating Information
Element 103. Driver Number
Element 104. Driver Name
Element 105. Age
Element 106. Marital Status
Element 107. Years Licensed Element 108. Driver's Training
Element 109. Assignment to Automobile -- Principal, Secondary, Occasional, Excluded
Element 110. Convictions -- Serious, Major, Minor
Element 111. Automobile Number
Element 112. Chargeable Claims (Date and Type) -- BI, PD, AB, COLL/AP
Element 113. Surcharges (Percentage and Description)
Element 114. Discounts (Percentage and Description)
Element 115. Kilometres Driven (Annually and To Work One Way)
Element 116. Gross Vehicle Weight Rating (commercial vehicles only)
Element 117. Class Description -- Class and Description
Element 118. Driving Record --BI, PD, AB, DCPD, COLL/AP
Element 119. Vehicle Code
Element 120. Rate Group
Element 121. Rate Group - AB, DCPD, COLL/AP, Comp/SP
Element 122. Rating Territory -- Territory Code and Description
Element 123. (Text) Lienholders (to whom loss may be jointly payable)
Element 124. Lienholders (if applicable) name and address
Element 125. (Text) Method of Payment
Element 126. Type of Payment Plan
Element 127. Total Policy Premium
Element 128. Tax
Element 129. Interest
Element 130. Total Payable
Element 131. Amount Paid with Application
Element 132. Amount Still Due
Element 133. Number of Remaining Instalments
Element 134. Amount of Each Instalment
Element 135. Instalment Due Date
Element 136. (Text) Remarks
Element 137. (Text) This Certificate is proof of a contract of insurance between the Named Insured and the Insurer, subject in all respects to the Ontario Automobile Policy (OAP 1). In return for the premium charged and the statements contained in the Application, the contract provides the coverage outlined in this Certificate. You only have a particular coverage for a specific automobile if this Certificate shows a premium for it, or shows
the coverage is provided at no cost. All other terms of the Policy remain the same unless stated otherwise in this Certificate.
Element 138. (Text) Your Insurer will provide you with a copy of the Policy if you request it.
Element 139. (Text) This Certificate is only valid if it is signed by an authorized representative of the
Element 140. Authorized Signature of Insurer:
Element 141. (Text) For purposes of the Insurance Companies Act (Canada), this document was issued
in the course of the Insurer’s insurance business in Canada.
Element 142. Brief explanation of insurance coverages and warnings. (Note: the following is a text element and the warning boxes are bolded.)
This is a brief explanation of the insurance outlined in this Certificate.
Provides coverage for you or other insured persons if someone else is killed or injured or their property is damaged in an automobile incident. It will pay for legitimate claims against you or other insured persons up to the limit of your coverage, and the cost of settling claims.
Your insurance company is obligated to explain details of Accident Benefits coverage to you.
Provides benefits that you and other insured persons are entitled to receive if injured or killed in an automobile accident. These benefits may include: income replacement for persons who have lost income; payments to non-earners who suffer complete inability to carry on a normal life; payment of medical, rehabilitation and attendant care expenses; payment of certain other expenses; payment of funeral expenses and payments to survivors of a person who is killed. You may also purchase optional benefits to increase the standard level of benefits provided in the policy. The optional benefits your insurance company must offer are: income replacement; medical, rehabilitation and attendant care; optional catastrophic impairment; caregiver, housekeeping and home maintenance; death and funeral; dependant care; and an indexation benefit.
Provides coverage if you or other insured persons are injured or killed by an uninsured motorist or by a hit-and-run driver. It covers damage to your automobile and its contents caused by an identified uninsured motorist.
Direct Compensation - Property Damage
Provides coverage in Ontario, under certain conditions, for damage to your automobile and to property it is carrying, when another motorist is responsible. It is called Direct Compensation because you will collect from us, your insurance company, even though you are not at fault for the accident. There may be a deductible amount, and this amount is either paid by you toward the cost of repairs or is deducted from the loss settlement. Higher deductibles may reduce your premium.
Provides a selection of optional coverages for your own automobile. Payments cover direct and accidental loss of, or damage to, a described automobile and its equipment. There is usually a deductible amount indicated for each coverage and this amount is either paid by you toward the cost of repairs or is deducted from the loss settlement. Higher deductibles may reduce your premium. There are four types of coverages:
- Specified Perils: Covers the described automobile against loss or damage caused by certain specific perils. They are: fire; theft or attempted theft; lightning; windstorm; hail or rising water; earthquake; explosion; riot or civil disturbance; falling or forced landing of aircraft or parts of aircraft; or the stranding, sinking, burning, derailment or collision of any kind of transport in or upon which the described automobile is being transported.
- Comprehensive: Covers a described automobile against loss or damage other than those covered by Collision or Upset, including perils listed under Specified Perils, falling or flying objects, missiles and vandalism.
- Collision or Upset: Covers damage when a described automobile is involved in a collision with another object or tips over.
- All Perils: Combines the Collision or Upset and Comprehensive coverages.
The Insurance Act provides that where (a) an Applicant for a contract, (i) gives false particulars of the described automobile to be insured to the prejudice of the Insurer, or (ii) knowingly misrepresents or fails to disclose in the application any fact required to be stated therein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured wilfully makes a false statement in respect of a claim under the contract, a claim by the Insured, for other than such statutory accident benefits as are set out in the Statutory Accident Benefits Schedule, is invalid and the right of the Insured to recover indemnity is forfeited.
Warning – Offences
It is an offence under the Insurance Act to knowingly make a false or misleading statement or representation to an Insurer in connection with the person’s entitlement to a benefit under a contract of insurance, or to willfully fail to inform the Insurer of a material change in circumstances within 14 days, in connection with such entitlement. The offence is punishable on conviction by a maximum fine of $250,000 for the first offence and a maximum fine of $500,000 for any subsequent conviction.
It is an offence under the federal Criminal Code for anyone to knowingly make or use a false document with the intent it be acted on as genuine and the offence is punishable, on conviction, by a maximum of 10 years imprisonment.
It is an offence under the federal Criminal Code for anyone, by deceit, falsehood or other dishonest act, to defraud or to attempt to defraud an insurance company. The offence is punishable, on conviction, by a maximum of 14 years imprisonment for cases involving an amount over $5,000 or otherwise a maximum of 2 years imprisonment.
This Certificate contains important information about your automobile insurance.