Child Car Seat and Booster Seat Reimbursement Application


Section 1 - Required information

* required  
Claim Number  *
Date of Loss  (dd-mmm-yyyy) *
Customer Name *
Telephone Number  *
Email Address *

Important: This application is only valid if the seat(s) have the National Safety Mark attached.

Section 2 - Reimbursement options

Select a seat reimbursement option. *
Option 1 - Reimbursement or allowance for the damaged seat(s) you are not replacing
Option 2 - Reimbursement or allowance for the damaged seat(s) you are replacing or have replaced

Note: You may be eligible for a full reimbursement or an allowance.

Section 3 - Damaged seat details and disposal options

Provide damaged seat(s) model details listed on the manufacturer's label.

Damaged
seat
claimed
Make Model Manufacturer's
Date

(dd-mmm-yyyy)
Expiry
Date

(dd-mmm-yyyy)
Seat 1
Note: List only the dates available on the manufacturer's label.
Add another seat, if more than one seat on the claim
Indicate which disposal method you plan to use for the damaged seat(s). Damaged seat(s) must be disposed and not re-used. *
I am disposing of the damaged seat(s) myself.
Important: You must send ICBC photographs of the:
  • manufacturer's label
  • National Safety Mark, and
  • car seat or booster seat that shows the safety straps are cut, or booster seat, that is unaltered, due to there being no safety straps attached to the seat.
I am delivering the damaged seat(s) to my nearest ICBC claim centre for them to dispose of it.
Important: You must send ICBC photographs of the:
  • manufacturer's label
  • National Safety Mark, and
  • car seat or booster seat that shows the safety straps are cut, or booster seat, that is unaltered, due to there being no safety straps attached to the seat.
I cannot dispose of my damaged seat(s) as not available due to a total loss, fire, or theft claim.

Section 4 - Damaged seat documentation

List the documents that will accompany your application to support your claim. Acceptable documents are originals of receipts and photographs. For unavailable seats, due to theft or fire, photographs are not required.

Damaged seat
claimed
Original receipts
for damaged seat
Photographs
Manufacturer's label Cut safety
straps
Seat 1 Yes
No

Yes
No
(please specify reason)

Yes
No
Add another seat, if claiming more than one seat

Section 4 - Replacement seat information

Did you purchase a replacement seat within 30 days of the date of loss? *
Yes
No (please specify reason)

Section 5 - Documentation

List the documents that will accompany your application to support your claim. Acceptable documents are originals of receipts and photographs.

Seat Damaged seat photographs Replacement seat
Manufacturer's label Shows cut safety straps Original receipts
Seat 1 Yes
No
(please specify reason)

Yes
No
Yes
No

Add another seat, if claiming more than one seat

Section 5 - Payment options

Select your preferred payment method for reimbursement: *
Automatic deposit into my bank account. ICBC offers customers reimbursement by Electronic Funds Transfer (EFT), for added convenience and quicker payment.
Yes, I have applied for EFT.
No, I have not applied for EFT, but I plan to apply. Set up direct deposit to receive your payments.
I prefer to receive reimbursement by cheque

Section 6 - Submit form

I have read and understand the Privacy Statement and Statement of Limitations for using this online application form. *

Important: You must submit your application to ICBC within two years of the date of loss.

Select how you will submit this application, and follow the steps that display after you make your selection: *
Email
Fax
Deliver
Mail

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