Vehicle Accident Form

Referring to your Service Agreement, Terms and Conditions in particular para 10, Loss Protection Plan. You have acknowledged financial responsibility for any damage to or loss of the Interlock installed in your vehicle, however, caused, provided you have paid the Loss Protection Plan fee. Your financial responsibility, therefore, shall be limited to $100.00 per occurrence (excluding any admin fees), if the following requirements are met:

• damage to or loss of the Interlock is not a result of a wilful act or omission on your part or other users of the Vehicle;  AND
  

• You present a copy of the police report, along with other evidence of loss and pay the $100.00 liability (excluding any admin fees) within 72 hours of loss.

• If the above conditions are not met you will be responsible for the full cost of the interlock which is $2,190.

You have been  granted a period of 30 days to have your vehicle repaired. Should the vehicle remain in a state of disrepair beyond this specified timeframe, you are required to arrange for the removal of the interlock system at your own expense plus any other fees associated with this removal. 

After the 30-day period has elapsed and the vehicle has not been repaired, you must contact Affordable Interlock Systems (AIS) to arrange for the removal of the interlock. The removal must be completed within 14 days of you contacting AIS for the removal. Failure to remove the interlock within the required timeframe may result in your account being referred to debt collection services.

Please be reminded that while the interlock is in your vehicle you will be required to continue to pay the monthly rental fee as per Clause 3 of your Service Agreement   "Participant obligation to pay Device Leasing Fee, together with any other fees and charges payable during the Term, shall continue, notwithstanding termination of this Agreement, until the Product has been returned to Service Agent in good condition subject to reasonable wear and tear."

If you are finding it challenging to maintain the device due to unforeseen circumstances such as vehicle breakdowns, removing the interlock device may help alleviate the associated obligations and fees.

By signing below, Participant hereby acknowledges and agrees with the conditions of the Loss Protection Program and the Vehicle in Disrepair as stated above.  Participant may elect to terminate the Service Agreement entered into between Participant and Service Provider pursuant Para 10 of its terms and conditions.  Participant acknowledges that early termination will be reported to the Administering Authority and may result in loss of driving privileges. Participant releases Service Provider and Authorized Service Agent, along with their employees, officers and directors, from any and all actions, causes of action, claims and demands relating to such early termination. 

Privacy Statement

Persuant to the Service Agreement, Affordable Interlock Systems (AIS) collects your personal information to provide you services. Information will be used by AIS and where relevant, may be shared with the applicable jurisdiction as a requirement by law. Your personal information will not be used for a further purpose or disclosed to a third party without consent unless authorised to required to by law. Further information about our privacy handling practices can be accessed  here

AIS-NET-O-014

03JUL2024 V1.0