DATA COLLECTION FORM CONCERNING THE CLASS ACTION SUIT AGAINST HONDA CANADA INC.

 
I - OWNER
Choose your APA office :
Name :
Email :
Address :
Telephone :
   
II - VEHICLE
Make :
Model :
Model year :
Date when put in service : (year-month)
Province where purchased :
Province Quebec          British-Columbia

Ontario           Other :

Vehicle bought :
Condition New                

Used

Vehicle ownership :
Propriétaire owned by private party

leased by private party

owned by corporation

leased by corporation

   

III - RECALL

       (Please provide the recall notice if available.)

Mileage at time of safety recall :

(km)
Date of repairs : (year-month)

Name of dealership where the repairs were performed :

   
Vehicles accessories that had to be disconnected to perform the repairs associated to the safety recall:
a. Anti-theft system Date of installation : (year-month)
Type of shop Dealer  Other
Time of installation Prior to vehicle delivery

After vehicle delivery

 

b. Remote starter Date of installation : (year-month)
Type of shop Dealer   Other
Time of installation Prior to vehicle delivery

After vehicle delivery

 

c. Alarm Date of installation : (year-month)
Type of shop Dealer   Other
Time of installation Prior to vehicle delivery

After vehicle delivery

 

d. Radio Date of installation : (year-month)
Type of shop Dealer   Other
Time of installation Prior to vehicle delivery

After vehicle delivery

 

e. Other Date of installation : (year-month)
Specify :
Type of shop Dealer   Other
Time of installation Prior to vehicle delivery

After vehicle delivery

 

Total fees charged for reconnecting the accessories disconnected during the repairs associated to the recall : ( CAN$)
 
Did you complain to anyone before paying of after having paid these fees?
Complaint

Yes No

If appropriate, please provide us with your complaint and the reply obtained.
   
Comments :

 

Please send all related documents to :

Montreal:
292 boul. St.-Joseph west
Montréal, Québec
H2V 2N7
Telephone: 514-272-5555
Fax: 514-273-0797
E-mail: apamontreal@apa.ca

Office hours : Monday to Friday, 9:00 to 5:00; closed from 12:00 to 1 :00 PM.