Special Vehicle Configure Permit Application
Long Combination Vehicle (LCV) Program
Ministry of
Transportation
1. Declaration
The applicant certifies that the information contained in this application is true and
acknowledges and accepts the responsibilities imposed by law on the applicant in relation to the operation of
a vehicle or combination of vehicles under the authority of the permit(s) issued pursuant to this application.
The applicant further acknowledges that this permit may be suspended, modified or cancelled pursuant to
Section 110.3 and/or 110.4 of the Highway Traffic Act.
Ministry Use Only
Fee $
Permit #
Y
Name & Signature of Authorized Applicant
2. Applicant Information
CVOR No. or N.S.C. No.
PRIO Account Number
Company Name (per Articles of Incorporation) or Last Name, First Name)
M
D
Staff Initials
Date
Date
Position / Title (if applicable)
Number of permits required
Do you require permit issued in bilingual format?
Street No. & Name or Lot, Con., Twp.
City, Town, Village
Province / State
Applicant's Name (Last Name, First Name)
Tel. No.
Fax No.
Email Address
Cell Phone No.
Fax No.
Email Address
X $440.00)?
Yes
Postal Code / Zip Code
3. Carrier's Primary LCV Contact Person
Tel. No.
Name/Position
4. Purpose of Application
This application is to request up to two SVC annual permits to operate Long Combination Vehicles (LCV) on Ontario's primary highway network
and to and from pre-approved origin/destination locations.
Only carriers who have been selected by the joint MTO/OTA/PMTC Selection Committee, and who provide the necessary approved
documentation as defined in the attached documents and as listed in Section 5, may make application under this program. Applications must
be submitted electronically, with all required support documentation scanned, and attached as .pdf (portable document format) files, and sent
by e-mail to [email protected].
Sequence, distribution and timing of permit production shall be according to a prescribed protocol established by the Selection Committee.
Permit applications will be processed according to this protocol, and not necessarily in the order that they are received. The applicant
acknowledges that the Ministry of Transportation reserves the right to suspend or cancel the LCV program at any time without compensation or
reimbursement of the fees or any incurred expenses.
Two copies of a Memorandum of Understanding (MoU) signed by MTO will be forwarded to eligible applicants. An authorized carrier official
must sign both copies of the MoU and return one to MTO verifying the carrier agrees to the Ontario LCV Pilot Program Conditions.
The permit(s) will be forwarded to the applicant upon receipt of the dully signed MoU but do not become valid until combined with copies of
letters from MTO specifying allowable primary routes, rest/emergency stop locations and origin/destination locations.
5. Supporting documents required to accompany each request
1. Carrier Abstract, dated no more then 30 days prior to this application, generated by the Carrier's home jurisdiction, clearly showing a
"Satisfactory" or better Carrier Safety Rating.
2. Documentation clearly illustrating that the carrier has at least 5 years experience in the trucking industry.
3. Copy of Carrier's Insurance Certificate, proving a minimum of $5 million liability insurance coverage. Carrier must provide MTO copies of
updated certificates throughout the eligibility period of the permit.
6. Payment and delivery options
Method of Payment :
Cheque
Method of Permit and MoU Delivery:
Credit Card
Picked up
Mailed
Prepaid Account
Courier
(charge my credit card)
Courier (use my account)
(Courier's Name & Acct. No.
Comments - Ministry use only
Personal information in this form is collected under the authority of Section 205 of the Highway Traffic Act and is used to evaluate eligibility to obtain a
overdimensional permit(s). Direct enquiries to: Weight & Load Engineer, MTO, Carrier Sanctions & Investigation Office, Oversize/Overweight Permit Section,
301 St. Paul St., 3rd floor, St. Catharines, ON L2R 7R4 (416) 246-7166 / 1(800) 387-7736.
SR-E-501E (2017/01)
© Queen's Printer for Ontario, 2017
Disponible en français
)
Credit Card Authorization Form
Applicant's Information
Office Use Only
Name / Company / Dealer
Operator No. Office No.
Street No. and Name, P.O. Box, R.R. or Lot, Con. and Twp.
Apt. / Suite No. Business Date
Y
City, Town or Village
M
D
Fee Paid
Postal or Zip Code
Prov. or State
Country
Email
Daytime Phone No.
Alternate Phone No.
Provide one (1) of the following Ontario identification numbers below.
If you do not have any of the information requested below check  the "Not Available / None of the above" box.
Driver's Licence (DL) Number:
Licence Plate Number:
Registrant Identification Number (RIN):
Dealer Number:
Commercial Vehicle Operator's Registration
(CVOR) Number:
National Safety Code
(NSC) Number:
Motor Vehicle Inspection Station (MVIS) Number:
Vehicle Identification Number (VIN):
Not Available / None of the above
Under provincial legislation, a false statement from the applicant may result in a penalty.
The personal information provided by you on this form is collected to assist with payment verification for the Ministry of Transportation’s
driver, vehicle and carrier products and services, for which the Ministry is responsible under the Highway Traffic Act. If you have any
questions about the information collected on this form, please contact the Operations Manager, ServiceOntario Driver & Vehicle Contact
Centre at 416 235-2999 or 1 800 387-3445 or visit ServiceOntario.ca.
Credit Card Information
Name of Credit Card Company
Print Name of Cardholder (as it appears on the credit card)
Visa
Mastercard
Print Name of Signing Authority (if different than name of Cardholder)
Signature of Cardholder and/or Signing Authority
Date
Y
X
SR-LV-034 2012/05 (p)
© Queen’s Printer for Ontario, 2012
Expiration Date
MM
© Queen's Printer for Ontario, 2017
D
Medium Sensitivity when completed
Credit Card Number (Print Clearly)
SR-LV-034E
M
Disponible en français
YY
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