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.