Fillable Garage Vehicle Certicate Declaration of Employees Worksheet (ICBC)

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Garage Vehicle Certicate Declaration of Employees Worksheet (ICBC)

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APV4AF (032018) Page 1 of 1
Garage Vehicle Certificate
Declaration of Employees Worksheet
NAME OF INSURED GARAGE VEHICLE CERTIFICATE NUMBER
Employee Categories (Note: part-time employees count the same as full-time employees.)
(A) Proprietors, partners, ofcers, managers, and salespersons; plus all employees whose duties consist principally of the operation of
vehicles.
(B) Clerical ofce employees including self service cashiers.
(C) All other employees not in class (A) or (B) (e.g., mechanics, body shop and parts people, etc.)
Total Number of Persons Employed by the Insured
Insert the number of employees per month in each category, and total per month all categories, for the 12 consecutive months ending
not more than 93 days prior to the effective date of this policy.
1
MONTH/YEAR
2
CATEGORY A
(AS ABOVE)
3
CATEGORY B
(AS ABOVE)
4
CATEGORY C
(AS ABOVE)
5
TOTAL OF 2, 3 & 4
1
2
3
4
5
6
7
8
9
10
11
12
Totals
Averages
This worksheet is provided as a courtesy. Use of this worksheet is at your own risk, and is not mandatory. This worksheet is not an
application for insurance and does not bind ICBC coverage.
Expiry Mo.
Yr.
V7 (112018)
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Garage Vehicle Certicate Declaration of Employees Worksheet (ICBC)

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Completed 11 February 2021

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