Firm Registration

Firm Registration

Step 1 of 8

IRIS ID
Hidden
Verified*
Please select the type of application you will be submitting*
For Wholesale/MGA Applicants, Have You Completed the Wholesale/MGA Firm Undertaking?
Click Here To Download & Complete the Wholesale/MGA Firm Undertaking
Attach Your Completed Wholesale/MGA Firm Undertaking Here:*
Max. file size: 256 MB.
Use the Link Above to Download & Complete the Wholesale/MGA Firm Undertaking
APPLICATION ATTACHMENTS:
Please review and complete each attachment required for your application. Incomplete, or missing, attachments will result in the delay in processing.
Do you intend on dealing in Auto insurance in Ontario?
To be eligible to deal in Auto insurance in Ontario, the firm MUST be assigned a Facility Servicing Carrier by the Facility Association. An application to be appointed to a Facility Servicing Carrier can be found under this link.

In order for firms to proceed with registration they must provide one of the following documents:

1) You will be required to sign a temporary No Auto Undertaking (Firm) and attach it to your application.

Click Here To Download & Complete the Temporary No Auto Undertaking

(Please email licensing@ribo.com proof that the firm was assigned a Facility Servicing Carrier and the No Auto Undertaking (firm) will be removed.)

OR

2) A letter from the Facility Association confirming that the firm has been assigned to a Facility Servicing Carrier
Attach Your Completed Temporary Auto Undertaking Here:*
Max. file size: 256 MB.
Please sign the Permanent No Auto Undertaking (Firm)
Click Here To Download & Complete the Permanent No Auto Undertaking (Firm)
Attach Your Completed Permanent Auto Undertaking Here:*
Max. file size: 256 MB.
Please Choose the Appropriate Principal Broker Undertaking for the Application Type Selected (Select 1):
Click Here To Download & Complete the Corporate/Partnership/Sole Proprietor PB Undertaking
Click Here To Download & Complete the Wholesale/MGA PB Undertaking
Click Here To Download & Complete the Non-Active PB Undertaking
Click Here To Download & Complete the Consulting PB Undertaking
Attach Your Completed Principal Broker Undertaking Here:*
Max. file size: 256 MB.
Use the Link Above to Download & Complete the Principal Broker Undertaking
Click Here To Download & Complete the Shareholder PB Undertaking
Attach Your Completed Shareholder Undertaking Here:
Max. file size: 256 MB.
Click Here To Download & Complete the Deputy Principal Broker Undertaking
Attach Your Completed Deputy Principal Broker Undertaking Here:
Max. file size: 256 MB.
Use the Link Above to Download & Complete the Principal Broker Undertaking
Click Here To Download & Complete the current dated Position Report (.pdf Format)
Click Here To Download & Complete the current dated Position Report (Excel Format)
Attach Your Completed current dated Position Report Here:*
Max. file size: 256 MB.
Use the Link Above to Download & Complete Your Position Report
Please Attach Articles of Incorporation, or Profile Report*
Max. file size: 1 MB.
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Please Attach Certificate of Errors & Omissions Insurance (NOT entire policy 10MB file size max.)
Max. file size: 10 MB.
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Please Attach Certificate of Fidelity Insurance (NOT entire policy 10MB file size max.)
Max. file size: 10 MB.
Please Attach a Copy of the Firm’s Corporate File Report and Articles of Incorporation.*
Max. file size: 256 MB.
Please ensure that either document includes proof that Principal Broker is a director/officer of the firm.
Please Attach a Copy of the Business Name Registration Document.
Max. file size: 256 MB.
Please upload a copy of the Business Name Registration document for each trade name from Service Ontario.
Please Attach copy of Letters of Intent (1)
Max. file size: 256 MB.
Please Attach copy of Letters of Intent (2)
Max. file size: 256 MB.
General Instructions
1. This form is to be used by all applicants seeking licensing as an insurance business registration under a sole proprietorship, partnership or corporation in the province of Ontario.

2. All applicable questions must be answered. Failure to do so may cause delays in the processing of the application. Pursuant to Section 26 of the Registered Insurance Brokers Act, the information provided in this form is privileged and confidential.

3. All applicable sections must be fully completed.

4. It is an offence under the Registered Insurance Brokers Act to knowingly make a false representation or declaration on this application and/or attachments, and doing so may be sufficient grounds under the Registered Insurance Brokers Act to reject the application or revoke a license.
GUIDELINES FOR REGISTRATION OF A NON-ACTIVE GENERAL INSURANCE BROKER BUSINESS IN ONTARIO
Principal Broker must be an individual who is personally registered as an insurance broker in Ontario, and whose registration is not “Restricted to Acting Under Supervision”. The Principal Broker is responsible for the firm’s compliance with the RIB Act, Regulation and By-laws. In the event that an individual holds an “Acting Under Supervision” registration, the Principal Broker requirement will be waived for the non-active member registration upon completion of the Undertaking. Please note that this consideration only applies to non-active business registrations.
SOLE PROPRIETORSHIP REGISTRATION ONLY
PARTNERSHIP REGISTRATION ONLY
DETAILS OF PARTNERSHIP
How Many Partners Are There in Addition to Principal Broker?
Partner #1*
First Last
Place of Residence*
City Province
Partner #1 Occupation*
Partner #1 Registration Number*
Partner #2*
First Last
Place of Residence*
City Province
Partner #2 Occupation*
Partner #2 Registration Number*
Please add any additional Partners here:
(Partner Name, Place of Residence, Partner Occupation, and RIBO Registration Number)
CORPORATION REGISTRATION ONLY
MGA/WHOLESALER REGISTRATION ONLY
CONSULTANT REGISTRATION ONLY
NON- ACTIVE CORPORATION REGISTRATION ONLY
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Registered Legal Name of Firm*
Date of Government Registration*
MM slash DD slash YYYY
Operating Name Used to Deal with Public (if different from Legal Name)*
Fiscal Year End*
MM slash DD slash YYYY
Headquarters Address (if outside Ontario)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Ontario Mailing Address For Service of Documents*
Street Address Address Line 2 City Province Postal Code
Phone Number*
Office Phone Number*
Name of Principal Broker*
First Last
Registration Number of Principal Broker*
Email*
Name of Deputy Principal Broker
First Last
Registration Number of Deputy Principal Broker

DIRECTORS AND OFFICERS (List all of the directors and/or officers)
Please List Company Directors here:*
(Director Name, Place of Residence, Director Position Held, Director Occupation, and RIBO Registration Number)
(Optional) Please Upload Your Director List Here
Max. file size: 256 MB.

Shareholders (List all of the shareholders)
Name

Occupation
Share Description

(Identify each class of shares held, number of shares held, and whether they are voting shares)
Name

Occupation
Share Description

(Identify each class of shares held, number of shares held, and whether they are voting shares)
Name

Occupation
Share Description

(Identify each class of shares held, number of shares held, and whether they are voting shares)
Please List Additional Shares Here:
(MAXIMUM CHARACTER: 250) Identify each class of shares held, number of shares held, and whether they are voting shares)

BANKING
Name, address and account number of bank(s) or institution(s) where trust funds and securities are deposited or held. Please attach a copy of the trust account cheque to the application. Please note: Trust account cheques must be clearly denoted “IN TRUST”
Do you have existing Trust Accounts outside the province of Ontario?*
Click Here To Download & Complete the Out-of-Province Trust Application
Please Upload your Out-of-Province Trust Application*
Max. file size: 256 MB.
Number of Trust Accounts*
Name of Bank*

Transit Number*

Trust Account Number

Please Attach Copy of Void Cheque*
Max. file size: 256 MB.
Please upload a copy of a void cheque with “in trust” clearly denoted on it or a letter from the bank confirming that the trust account is, in fact, a trust account.
Name of Bank*

Transit Number*

Trust Account Number*

Please Attach Copy of Void Cheque*
Max. file size: 256 MB.
Please upload a copy of a void cheque with “in trust” clearly denoted on it or a letter from the bank confirming that the trust account is, in fact, a trust account.
Name of Bank*

Transit Number*

Trust Account Number*

Please Attach Copy of Void Cheque*
Max. file size: 256 MB.
Please upload a copy of a void cheque with “in trust” clearly denoted on it or a letter from the bank confirming that the trust account is, in fact, a trust account.
BRANCH OFFICES
Name and address of all branch offices and name of the Deputy Principal Broker holding an Unrestricted registration to whom the responsibility of each of the branch operations has been delegated. Otherwise, provide a Plan of Supervision, outlining attendance schedule at each branch, how and by whom are each of the branch locations monitored, level of supervision of new and existing brokers “Acting Under Supervision”, type of binder control and follow-up system that exists and how trust funds are controlled and books and records kept relating to the branch office for each location.
Please Attach or List Additional Branch Locations
Address, Phone, and name of Principal or Deputy Principal Broker overseeing each location
Additional Branch Addresses
Max. file size: 256 MB.
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EMPLOYEE LIST
(Include only proprietor, partners, directors and employees registered at the date of application.)
List any additional Brokers or attach your current employee list
Attach your employee list here
Max. file size: 256 MB.
AFFILIATES OF MEMBER (OR EMPLOYER for NON-ACTIVE APPLICANTS)
(Include any members associated with applicant, ie. cluster arrangements, and parent companies, subsidiaries and members with common ownership)
Brokerage Name

Brokerage Name

Brokerage Name

NON-ACTIVE EMPLOYER
Brokerage Name*

Firm Registration Number*

INSURANCE MARKETS & SUB-BROKERAGES
List any insurance companies that have any direct ownership or any financial interest in your firm, those which you have received a loan/financing. Please indicate the name of insurer(s), % ownership or Amount of Equity or loan starting in ORDER OF VOLUME (if additional space is required, attach list)
Insurance Company

Direct Bill (Y/N)
Pay by Own / Company Statements
Insurance Company

Direct Bill (Y/N)
Pay by Own / Company Statements
Insurance Company

Direct Bill (Y/N)
Pay by Own / Company Statements
Insurance Company

Direct Bill (Y/N)
Pay by Own / Company Statements
Insurance Company

Direct Bill (Y/N)
Pay by Own / Company Statements
List or attach any Insurance Brokers through whom you place business as a sub-broker:
(MAXIMUM CHARACTER: 250)
Attach any Insurance Brokers through whom you place business as a sub-broker
Max. file size: 256 MB.
FINANCIAL GUARANTEES
Insurance Coverage (as required by Regulation 991, Section 20) Certificates of Insurance must be attached. The insurance policies must be on a form acceptable to the Manager and must contain a clause which provides for 30 day written notice to the Manager in the event of cancellation or non-renewal.
Errors & Omissions Amount*
Fidelity Amount*
Errors & Omissions Insurer

Fidelity Insurer

Errors & Omissions Policy Number

Fidelity Policy Number

E & O Expiry Date
MM slash DD slash YYYY

Fidelity Expiry Date
MM slash DD slash YYYY

Errors & Omissions Deductible*
Fidelity Deductible*
E&O Certificate Upload*
Max. file size: 256 MB.
Please ensure that all tradenames have been added as additional named insured.
Fidelity Certificate Upload
Max. file size: 256 MB.
Please ensure that all tradenames have been added as additional named insured.

Shared Space Exemptions
A brokerage wishing to share space is required to request an exemption to do so from RIBO’s Policy, Licensing and Standards Committee. A written request must be submitted with the application, and it will be reviewed by the Policy, Licensing and Standards Committee. The request must include the following items:
Is a Shared Space Exemption Required?*
Reason(s) why there is a need for sharing space:*
Description of other business(es) occupying adjacent space:*
Details of procedures to be taken by the brokerage to ensure there will be no risk of inducement, coercion or undue influence to control, direct or secure insurance business.*
Description of any relationship, shared ownership or other financial connection between the brokerage and other businesses on the premises.*
Floor plan showing location of each business office and physical separations.*
Max. file size: 256 MB.
Details of means of public access to each office, and the way in which it is proposed that the separate brokerage office premises will be identified.*
Please describe above, or upload an additional description below
Details of means of public access to each office, and the way in which it is proposed that the separate brokerage office premises will be identified.
Max. file size: 256 MB.
Steps taken to ensure confidentiality of the brokerage clients’ affairs (telephone, fax, incoming and outgoing correspondence).*
Details of security arrangement concerning client file information.*

Please Select YES or NO to each of the following:
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been registered or licensed in any capacity in any province, territory, state or country which required registration or licensing to deal in any class of insurance?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been registered or licensed in any capacity in any province, territory, state or country which required registration or licensing to deal with the public in any other capacity?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been refused registration or license mentioned in above or has any registration or license been suspended or cancelled that is mentioned above?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, operated under, or carried on business under, any name other than the name shown in this application?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been charged or convicted under the law of any province, state or country? (This includes any outstanding charge or indictment against the applicant or affiliate?)*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been a defendant or respondent in any proceedings in any civil court or tribunal in any jurisdiction in any part of the world where fraud, theft, deceit, misrepresentation, negligence or other similar conduct was alleged?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever declared bankruptcy or made a voluntary assignment in bankruptcy; or made any proposal relating to insolvency; or been the subject of proceedings relating to dissolution or winding up or had a receiver and/or manager appointed to hold its assets?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever had any judgment or garnishment rendered against it or is any judgment or garnishment outstanding against it in any civil court or tribunal in any jurisdiction in any part of the world?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been refused Errors and Omissions insurance or a Fidelity Bond or ever had Errors and Omissions insurance or a Fidelity Bond cancelled?*
If YES, please include or upload additional details*
File
Max. file size: 256 MB.
Is there any person or company whose name is not disclosed in this application who has any direct or indirect interest in the applicant, either beneficially or otherwise?*
If YES, please include additional details*
Does the firm carry on any business other than that of an insurance brokerage/consultant?*
If YES, please include additional details*
If YES, give full details, including the full name and address of the business and the nature of the business.
Click Here To Download & Complete the Secondary Business Exemption Form
Click Here To Download & Complete the Secondary Premium Business Exemption Form
Attach Your Completed Secondary Business (or Premium) Exemption Here:*
Max. file size: 256 MB.
Use the Link Above to Download & Complete Your Secondary Business Exemption
Does the firm hold an interest in any business other than that of an insurance brokerage/consultant?*
If YES, please include additional details*
If YES, give full details, including the full name and address of the business and the nature of the business.
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If you do not hold an Unrestricted registration, do you wish to take advantage of the no Principal Broker requirement by completing the Undertaking?*
Is the non-active firm a member of a cluster group? If yes, provide the name of the formal cluster name.*
Cluster Name

Is the non-active firm a partner in a corporate partnership? If yes, provide the name of the partnership.*
Partnership Name

Is the non-active firm being used for tax purposes only?*
Will the non-active firm hold trust funds?*
Will the non-active firm hold any insurance company contracts?*
Will the name of the non-active firm be on any advertisements, cards, circulars, letterhead, signs or be associated with any firm trading general insurance?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been registered or licensed in any capacity in any province, territory, state or country which required registration or licensing to deal in any class of insurance?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been registered or licensed in any capacity in any province, territory, state or country which required registration or licensing to deal with the public in any other capacity?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever been refused registration or license mentioned above, or has any registration or license been suspended or cancelled that is mentioned above?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, operated under, or carried on business under, any name other than the name shown in this application?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been charged or convicted under the law of any province, state or country? (This includes any outstanding charge or indictment against the applicant or affiliate?)*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been ever been a defendant or respondent in any proceedings in any civil court or tribunal in any jurisdiction in any part of the world where fraud, theft, deceit, misrepresentation, negligence or other similar conduct was alleged?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief, ever declared bankruptcy or made a voluntary assignment in bankruptcy; or made any proposal relating to insolvency; or been the subject of proceedings relating to dissolution or winding up or had a receiver and/or manager appointed to hold its assets?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever had any judgment or garnishment rendered against it or is any judgment or garnishment outstanding against it in any civil court or tribunal in any jurisdiction in any part of the world?*
Has the applicant, or any affiliate of the applicant, to the best of the applicant’s information and belief ever been refused Errors and Omissions insurance, or a Fidelity Bond, or ever had Errors and Omissions insurance or a Fidelity Bond cancelled?*
Is there any person or company whose name is not disclosed in this application who has any direct or indirect interest in the applicant, either beneficially or otherwise?*
Does the firm carry on any business other than that of a non-active insurance broker?*
If YES, please include additional details:*
If YES, give full details, including the full name and address of the business or the nature of the business.
Does the firm hold an interest in any business other than that of an insurance broker?*
If YES, please include additional details:*
If YES, give full details, including the full name and address of the business or the nature of the business.
CAUTION: It is an offence under the Registered Insurance Brokers Act to procure or attempt to procure registration by knowingly making any false or fraudulent representation or declaration. Filing of any false information or failure to disclose full information required by or on this application may result in its rejection or in disciplinary or other actions or proceedings being taken against the applicant and/or the RIBO member(s) within the provisions of the Registered Insurance Brokers Act or the Regulations, or may result in a refusal to register the applicant.
CERTIFICATION*
The undersigned Principal Broker hereby certifies, on behalf of the applicant firm that he/she is conversant with the provisions of the Registered Insurance Brokers Act, its Regulations and By-laws and that, if registered, the applicant firm will act in accordance with those provisions. The undersigned Principal Broker hereby further certifies, on behalf of the applicant firm that this application is complete and accurate and that the information provided is true and correct to the best of his/her knowledge, information and belief and hereby undertakes to notify RIBO in writing of any material change therein, within 30 days of such change, as provided by the by-laws. The undersigned Principal Broker, on behalf of the applicant firm, acknowledges and consents that RIBO may obtain any information whatsoever, from any source, as permitted by law in any jurisdiction in Canada or elsewhere.
CERTIFICATION*
The undersigned Principal Broker hereby certifies, on behalf of the applicant firm that he/she is conversant with the provisions of the Registered Insurance Brokers Act, its Regulations and By-laws and that, if registered, the applicant firm will act in accordance with those provisions. The undersigned Principal Broker hereby further certifies, on behalf of the applicant firm that this application is complete and accurate and that the information provided is true and correct to the best of his/her knowledge, information and belief and hereby undertakes to notify RIBO in writing of any material change therein, within 30 days of such change, as provided by the by-laws. The undersigned Principal Broker, on behalf of the applicant firm, acknowledges and consents that RIBO may obtain any information whatsoever, from any source, as permitted by law in any jurisdiction in Canada or elsewhere.
**In the event that I change employers, I am aware that to continue to be eligible for the non-active class of member registration, it is required that a new undertaking be completed and a copy of the updated Errors and Omissions information be forwarded.**
Principal Broker Name 2*
First Last
Email 2*

Date*
MM slash DD slash YYYY

Comments
This field is for validation purposes and should be left unchanged.

Step 1 of 8

APPLICATION ATTACHMENTS:

Please Choose the Appropriate Principal Broker Undertaking for the Application Type Selected (Select 1):

General Instructions

GUIDELINES FOR REGISTRATION OF A NON-ACTIVE GENERAL INSURANCE BROKER BUSINESS IN ONTARIO

SOLE PROPRIETORSHIP REGISTRATION ONLY

PARTNERSHIP REGISTRATION ONLY

DETAILS OF PARTNERSHIP

CORPORATION REGISTRATION ONLY

MGA/WHOLESALER REGISTRATION ONLY

CONSULTANT REGISTRATION ONLY

NON- ACTIVE CORPORATION REGISTRATION ONLY

DIRECTORS AND OFFICERS (List all of the directors and/or officers)

Shareholders (List all of the shareholders)

BANKING

BRANCH OFFICES

EMPLOYEE LIST

AFFILIATES OF MEMBER (OR EMPLOYER for NON-ACTIVE APPLICANTS)

NON-ACTIVE EMPLOYER

INSURANCE MARKETS & SUB-BROKERAGES

FINANCIAL GUARANTEES

Shared Space Exemptions

Please Select YES or NO to each of the following: