Consent and Notification

(This Consent and Notification is pursuant to the Federal Personal Information Protection and Electronics Documents Act)

I CONSENT to the Registered Insurance Brokers of Ontario collecting such additional information about me as may be necessary to complete or verify the information contained in my application to become a registered insurance broker of Ontario. The sources the Registered Insurance Brokers of Ontario may use are athletic associations; financial institutions; police forces (federal, provincial, municipal and foreign); current and former employers; credit bureaus; business associations; foreign governments; bankruptcy offices; insurance companies; Ministries of Finance and Consumer and Commercial Relations and/or the Financial Services Regulatory Authority of Ontario (formerly Financial Services Commission of Ontario); Employment and Immigration; Registrar General; governments of other provinces.

LEGAL AUTHORITY OF THE COLLECTION
Ontario Regulation 991, Section 5 under the Registered Insurance Brokers Act.

PRINCIPAL PURPOSES FOR WHICH THE PERSONAL INFORMATION IS INTENDED TO BE USED:

• to determine whether I am qualified and suitable to obtain the license I am applying for on this
application form and to consult with other regulatory bodies.
• to use and disclose such information for purposes which are consistent with the purpose set out in the
previous clause