APPLICATION FOR INSURANCE BROKER’S INDIVIDUAL REGISTRATION FORM 2A

GENERAL INSTRUCTIONS – PLEASE READ CAREFULLY

1. This form must be completed by all individuals seeking registration as an insurance broker in the province of Ontario. Pursuant to Section 26 of the Registered Insurance Brokers Act, the information provided in this form is privileged and confidential. Once registered, the individual is a member of the corporation.

2. 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 licence.

3. The application must be signed and all questions answered. Failure to do so may cause delays in the processing of the application.

4. You will also be prompted to submit a Criminal Background check via Sterling Back Check. License registrations will not be processed without this document.

5. All sections must be fully completed.