Car Insurance for BC Pharmacy Association Members

   
First Name: *   
Last Name: *   
Phone: *    
Email: *    
Policy (Plate) Number: *   
Policy Expiry Date: *   
Driver's Licence: *   
City: *   
Additional Information:
Please note any additional policies that need to be renewed here.
     Are you interested in private car insurance?
  Do you have optional insurance with a private insurance company?
  Important: By ticking this box and typing my name, I consent Westland Insurance Group Ltd. to accessing my ICBC account for policy details and if applicable I consent to receiving my personal information, insurance forms and, if applicable, banking information by email.

  I accept    
Name:     
  I agree and understand my insurance is NOT renewed and my coverage will NOT take effect until a licensed insurance representative has contacted me and has confirmed coverage is bound.

  I accept