How can you consult your file? (continued) If you already have a copy of your
You may also consult your file at
claims history statement The Fichier central
the offices of the Groupement des
assureurs automobiles on weekdays
Please contact the information officer
whose name appears on the statement. SINISTRES
des
between 8.30 a.m. and 4.30 p.m.
You will be required to present the
original copy of your driver’s licence
If you do not have your claims
history statement:
AUTOMOBILES
An ACCESSIBLE file in order to receive your statement Obtain it by following the stages
immediately. described opposite.
On the form, specify the information
Who may access your file?
Only you and an insurer may access
What should you do if you find to be checked. Want to know
a mistake in your file or if you
What is the Fichier central des your file. The information contained in
disagree with the information
You will first receive an acknow-
ledgement of receipt and a reply
MORE?
this public database is used in strict
sinistres automobiles (FCSA)? accordance with the provisions of the recorded in your file? will be sent to you within 20 days. For further information, please
It is a claims tracking database Automobile Insurance Act and the Act You can request a verification from contact an Insurance Information UNDERSTANDING
containing all automobile claims respecting Access to documents held by the Groupement des assureurs Centre officer at 514 288-4321 Your
incurred over the last six years, public bodies and the Protection of automobiles. or toll free at 1 877 288-4321. Statement
regardless of where the loss occurred, personal information. You can also consult the
the type of claim (accident, theft, www.infoinsurance.ca website
vandalism…) and whether or not How can you consult your file? (auto section).
you are liable.
Go to www.infoinsurance.ca website
and click on the Documents tab to
What purpose does
the FCSA serve?
obtain the form “Claims history
statement, verification and/or
DID YOU KNOW?
The FCSA enables your insurer to rectification request”. If you do not
determine your insurance premium have access to the Internet, please That when you report an automobile Effective April 1, 2009, accidents are
based on your automobile claims call 514 288-4321 or, toll free, accident or make a claim, your insurer attributed to the individual who has the
experience. 1 877 288-4321 to obtain the form. determines the extent of your liability custody of the vehicle at the time of the
and forwards this information to the accident. This may be the principal driver
Complete the form, sign it and FCSA. (main user of the vehicle), a regular or
Who oversees the FCSA? attach a legible photocopy of your an occasional driver, the owner of the
The FCSA is under the jurisdiction driver’s licence. Return these You must report all accidents, even if you vehicle or any other person operating the
of the Autorité des marches financiers documents to the Groupement do not intend to make a claim. In fact, this vehicle at the time of the accident. This
and this public database is des assureurs automobiles accident may be recorded in your file if the individual is not necessarily recorded in
administered by the Groupement by mail. other party receives a payment from their the insurance policy.
des assureurs automobiles. insurer.
Your insurer has the duty to Your claims history For example, if you lend your car to a
report any claim incurred over statement will be sent Since April 1, 2009, your insurer friend and if the vehicle is involved in an
the last six years to the FCSA. to you within 20 days. establishes your liability and reports accident, the accident will be recorded in
the accident to the FCSA, even if it your friend’s file.
makes no claim payment to you. This
disclosure offsets the version of the
other party’s insurer by indicating your
G-043-001F
800 Place-Victoria, Suite 2410
percentage of liability. P.O. Box 336, Stock Exchange Tower The Groupement des assureurs automobiles acts as an
Montreal (Quebec) H4Z 0A2 authorized agency of the Autorité des marchés nanciers
Claims history statement - Summary Page Reference 1 - Accident since April 1, 2009 Reference 2 - Accident before April 1, 2009
Understanding 1 Mister Sansnom
123 Street
FICHIER CENTRAL DES SINISTRES AUTOMOBILES FICHIER CENTRAL DES SINISTRES AUTOMOBILES
YOUR STATEMENT
Apt. 345 CLAIMS HISTORY STATEMENT CLAIMS HISTORY STATEMENT
City (QC) A1B 2C3
For any question concerning CONFIDENTIAL FILE CONFIDENTIAL FILE
this statement, contact
Mrs. Service 2
Tel : 514 288-3272
Toll Free : 1 866 665-FCSA (3272)
Period from 2003/06/15 to 2009/06/15 (6 years) Administration use only Period from 2003/06/15 to 2009/06/15 (6 years) Administration use only
FICHIER CENTRAL DES SINISTRES AUTOMOBILES FCSA Code FCSA Code
Name of the licence holder : Mister Sansnom Holder : 012345678 Name of the licence holder : Mister Sansnom Holder : 987654321
CLAIMS HISTORY STATEMENT Driver’s licence of the licence holder : S1111-111111-11 Other party : 901234567 Driver’s licence of the licence holder : X1111-111111-11 Other party : 009876543
CONFIDENTIAL FILE REFERENCE 1
REFERENCE 2
ACCIDENT DATE April 25 2009
The data and information of this record are confidential and transmitted by insurers to the Groupement des assureurs ACCIDENT DATE June 22 2008
automobiles under the provisions of section 177 of the Automobile Insurance Act (R.S.Q., Chapter A-25).
DATA RELATED TO THE LICENCE HOLDER
Pursuant to sections 178 and 179 of the Automobile Insurance Act, the Autorité des marchés financiers has authorized the DATA RELATED TO THE LICENCE HOLDER
Groupement des assureurs automobiles to act on his behalf to collect information to be transmitted to insurers for 9 Custodian (driver) of vehicle 15
classification and rating purposes. at the time of accident -- Principal operator QC S1111-111111-11
10 Driver at the time of accident QC S1111-111111-11 10 Driver at the time of accident QC S1111-111111-11
The person insured has, in respect of such information, the rights of access and correction provided for by the Act respecting Vehicle identification TOYO COROLLA 4DR, 2007 (000445) Vehicle identification TOYO COROLLA 4DR, 2007 (000445)
Access to documents held by public bodies and the Protection of personal information (R.S.Q., chapter A-2.1). 11 11 Vehicle type – version of :
Vehicle type – version of :
12 - this vehicle insurer Private passenger 12 - this vehicle insurer Private passenger
- the other party insurer Priv. passenger veh. - the other party insurer Priv. passenger veh.
3 Period from 2003/06/15 to 2009/06/15 (6 years) Administration use only 13 Liability % 0 13 Liability % 0
Reference : Total claim payment 10 890 $
Changes were made to the FCSA that better meet Name of the licence holder : Mister Sansnom Account : 14 Total claim payment 963 $ 14
4 Driver’s licence of the licence holder : S1111-111111-11 User code :SASSAS
8 DATA RELATED TO THE OTHER PARTY INVOLVED IN THE ACCIDENT
DATA RELATED TO THE OTHER PARTY INVOLVED IN THE ACCIDENT
consumer needs. SUMMARY :
5 6 7
---------------------- Version -----------------------
Licence holder
((and/or
Other party
involved in the
16 Driver at the time of accident
Vehicle identification
QC Z1234
HYUN ACCENT 3DR, 2006 (000531)
16 Driver at the time of accident
Vehicle identification
QC A4567
DODG COLT 2DR, 2000 (002258)
vehicle owner) accident and
17 17 Vehicle type – version of :
Vehicle type – version of :
Reference Date Vehicle identification and his insurer his insurer 18 - this vehicle insurer Private passenger 18 - this vehicle insurer Private passenger
- the licence holder insurer Priv. passenger veh. - the licence holder insurer Priv. passenger veh.
1 2009/04/25 TOYO COROLLA 4DR X X
Your claims history statement may contain two kinds
2 2008/06/22 TOYO COROLLA 4DR X X
Claim payment breakdown Claim payment breakdown
19 Coverage 20 Kind of loss 21 Payment 19 Coverage 20 Kind of loss 21 Payment
of information for claims that occurred: A) Third Party Liability (64) Property Damage Insured Veh. (16) 963 $ A) Third Party Liability (64) Property Damage Insured Veh. (16) 10 062 $
B) Third Party Liability (64) Loss of Use (18) 828 $
since April 1, 2009 (reference 1)
before April 1, 2009 (reference 2) 2009.06.15 Page 1 of 3
Groupement des assureurs automobiles, 800, Place-Victoria, suite 2410, P.O. Box 336, Stock Exchange Tower, Montreal (Quebec) H4Z 0A2
2009.06.15 Page 2 of 3
Groupement des assureurs automobiles, 800, Place-Victoria, suite 2410, P.O. Box 336, Stock Exchange Tower, Montreal (Quebec) H4Z 0A2
2009.06.15 Page 3 of 3
Groupement des assureurs automobiles, 800, Place-Victoria, suite 2410, P.O. Box 336, Stock Exchange Tower, Montreal (Quebec) H4Z 0A2
Claim payment breakdown
1 Name and address of the licence holder Summary Data related to the licence holder 12 Vehicle type – version of: Data related to the other party 19 Coverage: insurance policy coverage
requesting access to his/her file. > this vehicle insurer: rating of the involved in the accident under which the claim has been made
This section summarizes the claims Data provided by the insurer of the licence holder’s vehicle under the
2 Contact person for all file-related and code assigned to this type of
incurred by the licence holder over the vehicle involved in the accident or by insurance policy;
16 Driver at the time of accident: first five
requests. coverage.
six-year period referred to in Section 3. the insurer of the third party. characters of the driver’s licence number
> the other party insurer: licence holder’s of the driver of the other vehicle 20 Kind of loss: kind of loss that is the
3 Period: claims history contained in this 5 Reference: number identifying each 9 Custodian (driver) of vehicle at the time of vehicle body type. involved in the accident. subject of the claim and the code
Accident means any statement. claim shown in the file. accident: driver’s licence number of the
individual acknowledged as having 13 Liability %: percentage of liability 17 Vehicle identification: make, model and
assigned to this type of claim.
occurrence resulting 4 Driver’s licence of the licence holder:
driver’s licence number of the person
6 Date: date on which the accident occurred. charge of the vehicle at the time of the assigned by the insurer to the driver year of the other party’s vehicle, and 21 Payment: amount paid to insured for
accident. of the vehicle. code assigned to the vehicle. each coverage/kind of loss. The date on
in physical loss or damage, subject of the inquiry. 7 Vehicle identification: vehicle make and
model. 10 Driver at the time of accident: driver’s 14 Total claim payment: total amount paid 18 Vehicle type – version of:
which a loss reserve has been set up is
such as a collision, glass 8 Version: insurer that reported the claim licence number of the person operating to the insured for the accident. > this vehicle insurer: rating of the
shown if the claim has not yet been
settled. For example: in reference 2,
the vehicle at the time of the accident. vehicle of the other party involved in
breakage, vandalism, recorded in the FCSA.
11 Vehicle identification: make, model, year
15 Principal operator: driver’s licence
number of the principal operator named
the accident, under the insurance
the insured received a total claim
payment of $10,890 under two policy
policy;
property damage to a of the vehicle and code assigned to the in the insurance policy. The principal coverages: $10,062 for Third Party
vehicle. operator is not always the owner of > the licence holder insurer: vehicle body Liability – Property Damage and $828
third party or theft. This information is provided only if a claim has
been made or if an accident was declared.
the vehicle. type of the other party involved in the for Third Party Liability – Loss of Use
accident. (Replacement Vehicle).