ICBC Request Form

During COVID-19 we are available to assist you with ICBC transactions by phone or email. Please complete the form below and an agent will be in touch within the next two business days.

Insured Name 1

Date of Birth

Drivers License Number

Your privacy is very important to us. Seafirst Insurance Brokers wants to make sure your personal information remains safe and protected.
This is a consent for communicating by email and sending/receiving your personal information, insurance forms, and if applicable banking information by email. It is important that you understand the following conditions:
• Getting your information by email message may not always be secure. Your email could be broken into and your information could be seen, shared with others, or changed without your permission. We recommend deleting information from your email to reduce the risk to you.
• Depending on your email provider, information we send to you may be stored outside of Canada.
• If you delete email messages from Seafirst Insurance, backup copies could still be on your computer or in cyberspace.
• After your transaction is processed, you will be sent an email with your policy documents. ICBC requires you to respond to that email and tell us if you have accepted your policy terms. You’ll be given options to confirm your acceptance.

First Name

Last Name

Consent acceptance

Yes, I consent

Fill this out if vehicle is jointly owned.

Insured Name #2

Date of Birth

Drivers License Number

First Name

Last Name

Consent acceptance

Yes, I confirm consent

Expiry Date

Please note: If you are adding additional drivers to your policy, please be prepared with the driver's license number and date of birth for each driver you want to add to your policy.

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