Power of Attorney
Mandator (natural person being represented)
Mandator and Mandatary
Please ll out the form using UPPER CASE LETTERS with a black or dark blue pen.
Year Month Day
As mandator, I, the undersigned, authorize the mandatary named above to act on my behalf concerning the following transaction:
, on
(Describe the requested transaction [e.g. driver’s licence or vehicle registration renewal,
vehicle ownership transfer, replacement of a registration certicate, vehicle storage, vehicle discarding])
(Place of signature)
Vehicle Description
SECTION 2 (Complete for all transactions in connection with a vehicle)
Date of birth
Mandatary (natural person of full age agreeing to represent the mandator)
Québec driver’s licence
reference number
(No piece of identication is required)
A) Declaration of the TRANSFEROR being represented (mandator)
Declaration of Transfer of Ownership
(The mandator must complete and sign the appropriate declaration [A or B], for transfers only)
B) Declaration of the ACQUIRER being represented (mandator)
I declare that the odometer reading was
Acquirer’s signature
Transferor’s signature
New owners name (print):
Notice to readers: This document complies with Québec government standard S G Q R I 0 0 8 - 0 2 on the accessibility of downloadable documents. If you
experience difficulties, please contact us at: 1 800 3 6 1 – 7 6 2 0.
SECTION 1 (Complete and sign for each transaction)
Last name First name Québec driver’s licence number
Full address
Last name First name Québec driver’s licence number
Full address
(Provide one of the pieces of
identication listed on Page 2)
This power of attorney is valid until
I have signed in
Mandator’s signature
Vehicle identication number (VIN)
Model Year Licence plate number
I declare that I:
(check the appropriate box)
sold my vehicle for the sum of: $
gave away my vehicle.
(check the appropriate box)
Société de l’assurance automobile du Québec
5498A 30 (2021
Page 1 of 2
Original document in French.
Power of Attorney (Natural Person Only)
The Power of Attorney form must be lled out, signed and dated by an individual who cannot go in person (mandator) to the
Société de l’assurance automobile du Québec (SAAQ) and who wants to authorize another person (mandatary) to conduct,
on the mandators behalf, a transaction in connection with the mandator’s record. Once completed, the power of attorney contains condential
information that could be used for other purposes, which is why the SAAQ recommends only giving a power of attorney to
someone you trust and keeping a copy of the document.
General Instructions
A Power of Attorney form that is not completed in accordance with the instructions or on which entries have been
erased, crossed out or altered will not be accepted.
If the person being represented chooses to enter his or her date of birth in the “Mandator” part of Section 1, the
mandatary must be provided with an original piece of identication accepted by the SAAQ.No piece of identication is
required if the person chooses to enter the Québec driver’s licence reference number.
A fax or copy of a duly completed form can be accepted only if the required signature(s) is/are original.
The mandatary (person representing the mandator) must be age 18 or older and will have to provide one piece of
identication accepted by the SAAQ.
Vehicles registered as co-owned or jointly-leased: For any transaction other than a transfer of ownership of the vehicle,
one of the individuals whose name appears as co-owner or co-lessee on the registration certicate must come in person
or provide a power of attorney. Contact the SAAQ to nd out the requirements that apply to the transfer of ownership of
this type of vehicle.
Additional Instructions Concerning a Transfer of Ownership
If you give a power of attorney because:
You are selling or giving away your vehicle:
Complete and sign Sections 1, 2 and 3A.
Remember that you remain responsible for the vehicle until it is registered in the acquirer’s name. It is your respon sibility
to ensure that the vehicle is registered under the acquirer’s name.
You are acquiring a vehicule:
Complete and sign Sections 1, 2 and 3B.
If the acquirer is absent, the mandatary will not be allowed to proceed with the transfer if the odometer reading reported
insection 3B is less than what was declared at the time of the previous vehicle registration. The acquirer can ask the
transferor for explanations or go in person to authorize the SAAQ to proceed with the transfer if the acquirer still wishes
to do so.
Before making the transfer, verify whether the vehicle can be registered by calling 1-900-565-1212 or using the
Checking if a Vehicle Can be Registered online service on the SAAQ website at saaq.gouv.qc.ca. Fees are charged
for each consultation.
To give away or sell a vehicle registered in Québec, between related individuals, both parties must submit:
The Declaration of a Transaction Between Related Individuals with Regard to a Road Vehicle Registered in
Québec (VD-80.1-V) form from Revenu Québec, duly completed.
A document proving kinship.
2. For further information or to nd out which documents are accepted to prove kinship, contact the SAAQ call centre at
418-643-7620 in the Québec area, 514-873-7620 in the Montréal area, or 1-800-361-7620 (Québec, Canada, United States),
or consult the SAAQ website (saaq.gouv.qc.ca).
Use of the Power of Attorney
1. Original pieces of identication accepted by the SAAQ:
— Licence authorizing the operation of a vehicle
— Identity card issued by the SAAQ
— Certicate of Canadian citizenship with photo
— Permanent Resident Card
— Passport
— Certicate of Indian Status card
— Health Insurance Card
Taxi driver’s permit
— Peace officer’s identity card
— Canadian Armed Forces identity card
Protection of Personal Information
All personal information gathered by authorized Société de l’assurance automobile du Québec (SAAQ) personnel is handled condentially. The SAAQ
requires this information to apply the laws it is responsible for administering, in particular the Highway Safety Code, the Automobile Insurance Act and
the Act respecting remunerated passenger transportation by automobile. Under the Act respecting Access to documents held by public bodies and the
Protection of personal information, this information may be conveyed to the SAAQ’s licensing agents and other Government departments or agencies, or
used for statistical, survey, study, audit or investigative purposes. Failure to provide this information can result in a refusal of service. You may consult, correct
or obtain a copy of any personal information concerning you.
For more information, consult the Policy on Privacy on the SAAQ’s website at saaq.gouv.qc.ca or contact the SAAQ’s call centre.
Société de l’assurance automobile du Québec
5498A 10 (2021-01)
Page 2 of 2
Original document in French