CL96 (092017) Write-off Agreement
Original - Claim File
Copy - Registered Owner
Write-off Agreement
REGISTERED OWNER(S) DATE OF LOSS (ddmmmyyyy) CLAIM NUMBER LOC. CODE
REGISTERED OWNER(S) ADDRESS
RESOURCE NAME RESOURCE NUMBER
LICENCE PLATE OR POLICY NO.
PROVINCE REGISTRATION NUMBER YEAR MAKE MODEL
VEHICLE/
TRAILER
DESCRIPTION
L
SERIAL NUMBER LOCATION OF VEHICLE
PLEASE READ BEFORE SIGNING
The vehicle has been damaged in an accident. ICBC will determine whether it is economical to repair. If it is not, ICBC will arrange
to sell the vehicle and pay a settlement amount to you. The purpose of this agreement is to allow ICBC to proceed with your claim
in this manner.
• This Agreement gives ICBC permission to tow the vehicle.
• If ICBC determines that it is not economical to repair the vehicle, this Agreement gives ICBC authorization to sell the vehicle.
• The vehicle may be sold before your claim is settled. However, signing this Agreement does not affect the settlement amount
you may be entitled to receive for the vehicle.
• Signing this Agreement does not automatically cancel the insurance on the vehicle. If the vehicle is not repairable, please
contact your Autoplan broker to discuss your options. Be sure to have:
•
Your current ICBC insurance papers for the vehicle
•
Both of the vehicle’s licence plates
• The vehicle may contain personal information, including electronic data stored in a GPS Unit or in-system vehicle computer.
Please consult your Owners’ Manual and, where possible, remove/delete this information.
I DECLARE THAT
I am the registered, and also the sole legal or benecial owner of the vehicle.
If ICBC deems the vehicle not economical to repair, I transfer all rights, title and interest in the vehicle to ICBC.
I conrm that as at the date this form is signed, there are no liens/encumbrances registered or pending against the vehicle
except:
SIGNATURE OF REGISTERED OWNER DATE
SIGNATURE OF REGISTERED OWNER DATE
