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CL113D - Courtesy and Rental Vehicle Reimbursement
Submitted forms will be processed by the centralized Loss of Use Team.
 
* required
Repair Shop Name:   
Repair Shop Email: 
Account Number:  A
Registered Owner: 
Claim Number: 

Courtesy Vehicle Provided  From   (DD-MMM-YYYY)
to        (DD-MMM-YYYY)  *

Reason:   *
Note:  Please provide PVRT information on the Vehicle Repair Cycle Time Capture System (VRCTCS).
Total Days:  (i)
Rate per Day $:  (ii)
Courtesy Vehicle Allowance Total $ (i x ii) (a)

Is the insured a GST Registrant? No Yes    
Percent (%):   

PST $:  (b)
ICBC Portion GST $:  (c)
Customer Portion GST $: 
(shop to collect from customer)
Is the insured an HST Registrant? No Yes    
Percent (%):   

ICBC Portion HST $:  (b)
Customer Portion HST $: 
(shop to collect from customer)
Note:  PVRT only applies if a courtesy vehicle is supplied in excess of 8 consecutive hours and for 28 or less consecutive days.
PVRT Number of Days:  (i)
PVRT Daily Rate $:  (ii)
PVRT Total $ (i x ii) (d)

ICBC Portion GST $:  (e)
Customer Portion GST $: 
(shop to collect from customer)

 
Invoice Total $: 
  
  

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   (072022)