Forms and documents​

For crashes that occurred on or before April 30, 2021: use the forms on this page.

For crashes occurring on or after May 1, 2021: please contact the relevant claim representative to request the form(s) you need.

Private investigators​

• Private Investigator Established Rates and Regions
• New/change vendor application professional (CL174D)
• Itemized Statement of Account (private investigator) (CL268)
• Performance Standards for Private Investigators (CL356)
• Submit Multimedia Devices to ICBC (CL486)

Independent adjusters

• Independent Adjuster Established Rates
• ​Independent Adjuster Invoice (CL315)
• Independent Adjuster Activity Log (CL315A)
• Performance Standards for Independent Adjusters (CL344)

Forms

• New/Change Vendor Application Professional (CL174D)
• Vehicle Identification Request (WEB1579)

Medical, wage loss and benefit applications

• Certificate of Earnings (CL15)
• Detailed Wage Loss (CL15A)
• Fatal Accident Benefits Application (CL21)
• Head Injury Symptoms Questionnaire (CL29C)
• Functional Requirements Questionnaire (CL432)

Authorizations and advance payment agreements

• Advance Payment Agreement (CL230)
• Advance Payment Agreement Part 7 (CL230A)
• Authorization to Furnish Employment and Benefits Information (CL237)
• Authorization to Provide Medical Information (CL237A)
• Authorization for Release of Patient Information (CL237B)
• Authorization for ICBC to Release Wage Loss Information (CL237C)
• Authorization to Release Educational Information (CL237D)
• Request and Authorization to Provide Medical Information (CL237E)
• Authorization for WorkSafeBC (CL237J)

Infant claims

• Guardian Settlement Agreement (CL29)
• Payment Notice to Public Trustee (CL29A)
• Infant Settlement Proposal (CL29B)
• Child/Parent/Guardian Questionnaire (CL29D)
• Guardian Settlement Agreement and Assignment (Uninsured) (CL29E)
• Guardian Settlement Agreement - Represented (CL29F)

Material damage and property damage

• Automobile Proof of Loss (CL37)
• Property Damage Release (CL38)
• Salvage Release (CL96)

Hit and run and unidentified

• Statutory Declaration (CL42)
• Application for Payment Under Section 24 (CL45)

Releases

• Final Release (CL39)
• Release and Agreement (CL39A)
• Release and Assignment - Uninsured - Out-of-Province (CL39C)
• Release and Assignment (Uninsured) (CL39D)

ICBC respectfully acknowledges that we are privileged to live and work on the traditional and ancestral homelands, both unceded and treatied, of Indigenous Peoples and Nations across British Columbia, each with their own unique traditions, histories and cultures.

We're committed to learning how to better partner with Indigenous communities to further reconciliation. We support employees on their individual paths towards reconciliation and encourage expressions of Indigenous culture at the workplace. We recognize that we are early in our reconciliation journey and will provide more information on the actions we're taking as we progress.

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