Forms and documents​

Independent adjusters

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)

• Insurance Claim Application (CL22)

• 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)