Revised Certificate of Automobile Insurance form (Declaration Page) and approved data elements



No. A-07/96
- Auto
Property & Casualty

To the attention of all insurance companies licensed
to transact automobile insurance in Ontario


This Bulletin introduces the revised specimen "Certificate of Automobile Insurance (Ontario)" form, also called the "Declaration Page" , that is to replace the existing one for use with the owner's policy.  It also introduces, for insurers wishing to custom design their own certificate, a revised list of the required data elements.


A revised certificate must be used for all new and renewal business with the effective date of November 1, 1996, the implementation date for Bill 59, the Automobile Insurance Rate Stabilization Act, 1996.  Insurers that wish to use their own custom designed certificate must obtain approval from the Ontario Insurance Commission (OIC), as required under Section 232(5) of the Insurance Act.


Other forms will also be affected by the provisions of Bill 59: the "Application for Insurance" form (OAF 1); the "Ontario Automobile Policy" form (OAP 1); and other policy forms,  policy change forms (endorsements), and accident benefit claim forms.  They will be sent to you in the near future so that you can begin to prepare for their use. 


All new and revised automobile insurance forms, as well as other forthcoming changes associated with the implementation of Bill 59, are being developed in consultation with the industry. 



We are enclosing for your information the following materials:


  1. A specimen " Certificate of Automobile Insurance (Ontario) " form.

  2. A list of the data elements for the certificate.

  3. Explanatory notes about the data elements.                                   

Guidelines on use of forms


The OIC has developed a specimen certificate.  If you wish to use this as the certificate that will be issued to consumers, you will not need approval from the OIC.   However, you must file a copy of the form with the OIC’s Rates and Classifications Branch.  The copy should include your company logo, and an example of how the form would be completed.


If you are designing your own certificate based on the data elements provided in this Bulletin, it must be approved by the OIC.  In this case, you should, as soon as possible, submit to the OIC the following:


  • one copy of the blank certificate;
  • and another copy of the certificate showing how you would complete it before issuing it to a consumer.

Printing arrangements


If you have your own printer and wish to obtain the form on disk, please send your request by fax to the attention of the Administrative Officer, Public Affairs, Corporate Operations branch, OIC, indicating the title of the form you wish to acquire.   The fax number is (416) 590-7070.

OIC Contact


If you need additional information on this new form, please contact your rate analyst in the Rates and Classifications Branch at the OIC.

D. Blair Tully

August 15, 1996

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