ICBC Consent Request

Which Gold Key Location?*

Surrey Head Office 5 – 8430 128TH St. Surrey, BC. V3W 4G3Vancouver Branch - 4038 Knight St. Vancouver, BC. V5N 5Y7North Vancouver Branch - 110 - 845 Marines Dr. North Vancouver, BC. V7P 0A8

Under Personal Name or Company Name?

Personal NameCompany Name

Company Name

First Name*

Last Name*

Phone Number on ICBC Account*

Email*

Postal Code*

Date of Birth*

Date

Expiry Date Of Your ICBC Policy*

Date

Licence Plate*

Make of Car*

Surrey Head Office - ICBC Team

GOLD Team

North Vancouver ICBC Team

BehnushShawnaSheny

Vancouver Oakwest Branch ICBC Team

ErnestGraceWendy

ICBC Fleet & Trucking Team

Vancouver ICBC Team

Attach Odometer Picture or send later

Your privacy is very important to us. Gold Key Insurance Services Ltd. 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 Gold Key Insurance Services Ltd., 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.

Yes I Agree

Thank you for visiting our secure Gold Key Insurance ICBC Consent request page, for over the phone transactions.

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