CL113H - Notification for Direct Rental Referral

Complete and submit this form to the handling Claim Centre (as outlined in the collision repair program guide) when collision repair program participant determines they are unable to satisfy a customer (with access to coverage for expenses incurred in renting a replacement vehicle) through ATS.

ICBC will contact the customer to discuss/arrange rental vehicle needs.

If ICBC does not receive this form as outlined in the collision repair program guide, then the participant must meet all of the customer's alternate transportation needs for the duration of the repair.

Note: To see the locations and dates applicable to this form, please visit the collision repair program page.

* required
Location	Lower Mainland Outside Lower Mainland *
Claim Office Location		*
Repair Shop Information
Repair Shop Name		*
Facility Number		*
Address		*
City		*
Postal Code	*
Repair Shop Email		*
Repair Shop Phone Number	*

Claim Information
Claim Number	*
Registered Owner Name		*
Contact Phone Number 1	*
Contact Phone Number 2

Rental Vehicle Required	(DD-MMM-YYYY) * Time :a.m.p.m. *
Unable to Provide ATS Due To		*
Anticipated Repair Time		*

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		CL113H (072022)