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Remedial Program Referral Application for Reconsideration

Office of the Superintendent of Motor Vehicles

The personal information on this form is collected under the authority of the Motor Vehicle Act (RS British Columbia 1996, c. 318, s. 215.48) and the Freedom of Information and Protection of Privacy Act (RS British Columbia 1996, c. 165, s. 26 (a) and (c)). The personal information collected will be used by the Office of the Superintendent of Motor Vehicles to facilitate the reconsideration of the remedial program referral referred to herein. If you have any questions about the collection, use and disclosure of the information collected, contact the Office of the Superintendent of Motor Vehicles, at PO Box 9254 Stn Prov Govt, Victoria BC V8W 9J2, phone (250) 387-7747.

Provide the following information:

SURNAME (please print clearly) GIVEN NAMES

STREET ADDRESS

CITY

PROVINCE

POSTAL CODE

BC DRIVER’S LICENCE NO.

PHONE NUMBER

ATTACHMENTS PROVIDED : _____________ PAGES

SIGNATURE DATE (yyyymmdd)

RECONSIDERATION OF REFERRAL TO:

RESPONSIBLE DRIVER PROGRAM

IGNITION INTERLOCK PROGRAM

Instructions for applying for a Remedial Program Referral Reconsideration

This reconsideration process is available for referrals made by the Superintendent of Motor Vehicles under section 25.1 of the Motor Vehicle Act. You may request a reconsideration if you have received a Notice of Referral to Remedial Programs. Remedial Program Referral Reconsiderations do not include a review of any driving prohibitions received that led to your referral.

Clients seeking a reconsideration must send a written submission along with this completed Application for Reconsideration to the Office of the Superintendent of Motor Vehicles via mail or fax at: The Office of the Superintendent of Motor Vehicles PO BOX 9254 STN PROV GOVT VICTORIA BC V8W 9J2 Facsimile: (250) 953-8639 Your written submission must:  Provide reasons why you believe the referral should be...