Fillable Written Off Agreement Vehicle Transfer Private Insurer (ICBC)

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Written Off Agreement Vehicle Transfer Private Insurer (ICBC)

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The Written Off Agreement Vehicle Transfer Private Insurer (ICBC) form is 1 page long and contains:

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APV366 (122017 ) Written Off Agreement — Vehicle Transfer — Private Insurer Page 1 of 2
Written Off Agreement — Vehicle Transfer — Private Insurer
TO BE COMPLETED BY THE INSURANCE COMPANY
Insurance Company Details
INSURANCE COMPANY NAME CLAIM NUMBER
INSURANCE COMPANY ADDRESS
CLAIM REPRESENTATIVE NAME PHONE NUMBER FAX NUMBER
VEHICLE STATUS MUST BE CHANGED TO
Salvage Dismantle Dismantle/Flood
I declare that
The above company hereby provides notice to ICBC that the following vehicle has been written-off and title to the vehicle is being
transferred to
(INSURANCE COMPANY) as part of a claims settlement.
SIGNATURE
(Insurance Company Representative)
NAME TITLE PHONE NUMBER DATE (ddmmmyyyy)
TO BE COMPLETED BY THE VEHICLE OWNER
Vehicle Description
BC REGISTRATION NUMBER COLOUR FUEL YEAR MAKE MODEL BODY STYLE
VEHICLE IDENTIFICATION NUMBER (VIN) PLATE NUMBER SEATING CAPACITY NET WEIGHT (kg) GROSS WEIGHT (kg) DISP (cc)
Owner Information and Vehicle Declaration
REGISTERED OWNER(S) NAME REGISTERED OWNER(S) ADDRESS
DATE OF SETTLEMENT (ddmmyyyy) OWNER’S BC DL NUMBER OWNER’S BC DL NUMBER
ODOMETER READING
odometer replaced/broken
km miles
PREVIOUS VEHICLE HISTORY
Has vehicle ever been used for:
Vehicle previously registered outside of BC:
Rental Lease Emergency or Police Taxi None of these
Yes No
CUMULATIVE VEHICLE DAMAGE
New vehicle where damage exceeded 20% of asking price:
Used vehicle damage over $2000:
Yes No
Yes No
Please read before signing
This vehicle has been damaged in an accident.
(INSURANCE COMPANY) has determined it is not economical to repair and
will arrange to sell the vehicle and pay a settlement amount to you.
The purpose of this agreement is to allow (INSURANCE COMPANY) to
proceed with your claim in this manner.
• This agreement gives the insurance company authorization to assume legal title to the vehicle, and to sell the vehicle.
• Signing this agreement does not automatically cancel the insurance on the vehicle. 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 benecial owner of the vehicle.
I transfer all rights, title and interest in the vehicle to
(INSURANCE COMPANY).
I conrm that as at the date this is signed, there are no liens/encumbrances registered or pending against the vehicle, except:
SIGNATURE OF REGISTERED OWNER DATE (ddmmmyyyy) SIGNATURE OF REGISTERED OWNER DATE (ddmmmyyyy)
APV366 (122017 ) Written Off Agreement — Vehicle Transfer — Private Insurer Page 2 of 2
Signatures — where the seller or purchaser is a registered company, the signatures required are of signing ofcer(s) with ofcial title(s) with
the company.
Note: Business names not registered with the Corporate Registry, Victoria, BC, may not be used.
FUEL TYPE CODES
Code Fuel Type
A Alcohol
B Butane
D Diesel
E Electric
Code Fuel Type
F Diesel - Butane
G Gasoline
H Gasoline — Alcohol
L Gasoline — Electric
Code Fuel Type
N Natural Gas
P Propane
R Diesel — Natural Gas
S Propane — Natural Gas
Code Fuel Type
T Diesel — Propane
U Gasoline — Natural Gas
W Gasoline — Propane
Y Hydrogen
Z Multi-Fuel
SUBSTITUTE VEHICLE:
An owner of a BC-licensed and insured vehicle may transfer the number plates to a newly-purchased BC vehicle and operate the vehicle
for a maximum period of 10 days from purchase date provided ALL of the following conditions are met:
• the newly purchased vehicle is the same type and the plates are valid and compatible (e.g., passenger plates on a passenger vehicle,
commercial plates on a commercial vehicle); AND
• the newly purchased vehicle is a BC registered vehicle or is a new vehicle purchased from a BC registered dealer; AND
• title or interest in the original vehicle has been transferred.
During the 10-day period the operator must carry all the following documents, and produce to a Peace Ofcer upon request:
• the Purchaser’s copy of the completed, dated, and signed Transfer/Tax Form (APV9T); and
• the Purchaser’s Owner’s Certificate of Insurance and Vehicle Licence for the transferred original vehicle; and
• the previous owner’s Certificate of Registration for the newly-purchased vehicle, or a signed and dated Bill of Sale if brand new vehicle
purchased from a BC Registered Dealer.
NOTE:
If the original licence plates are not compatible with the newly-acquired vehicle, or if the title to or interest in the original vehicle has not
been transferred, the 10-day substitute vehicle provision cannot be used, and the vehicle must be registered and licensed immediately with
compatible plates, before being used on a highway. Attend an Autoplan Agent. You will need to complete and sign a Transfer/Tax Form
(APV9T), and your broker will process the transfer of ownership, collect any fees, taxes and premium owing, and issue new (compatible)
plates. No insurance is in force on the vehicle until the transfer is processed and new compatible plates are issued.
All newly purchased vehicles must be registered in the name of the licence holder at an Autoplan Agent within 10 days of purchase.
PRIVACY NOTICE:
The personal information on this form is collected: (a) by ICBC for the purpose of considering the application by seller and purchaser
of the transfer of vehicle ownership and is authorized by the Motor Vehicle Act, the regulations thereunder and other related legislation;
(b) by ICBC for the purpose of administering the Provincial Sales Tax Act and regulations thereunder, Excise Tax Act and the regulations
thereunder, and (c) by the Ministry of Finance (“Ministry”) for the purpose of administering the Excise Tax Act and the regulations
thereunder and Provincial tax legislation. Each of ICBC and the Ministry may use and disclose this information in accordance with the
provisions of Part 3 of the Freedom of Information and Protection of Privacy Act. Questions about the collection of this information can be
directed to: (a) for ICBC, to the Manager, Information and Privacy, by phone 604-661-2800 or to this address: ICBC, PO Box 5050 Station
Terminal, Vancouver BC V6B 4T4; (b) for the Ministry, to the Manager Program Services Section, at, Ministry of Finance, by phone toll-free
at 1-877-388-4440 and ask to be re-directed, or to this address: PO BOX 9442, Stn Prov Govt, Victoria, BC V8W 9V4.
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Written Off Agreement Vehicle Transfer Private Insurer (ICBC)

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Completed 11 February 2021

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