Audit - Module J - GENERAL - Registered Insurance Brokers of Ontario (RIBO) - Ontario's regulator of general insurance brokers"

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Auditor

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Date Assigned

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Auditor Email

Contact Details

Principal Broker Name(Required)

First Last

Your Name(Required)

First Last

Your Email(Required)

General

Brokerage Name

License Number(Required)

What Broker Management System (BMS) does your firm use?(Required)

Please provide an explanation(Required)

Please attach the most current shareholder structure of your firm.(Required)

Max. file size: 256 MB.

Please provide the entire copy of your firm's most recent E&O and Bond insurance policies, including policy wordings.(Required)

Drop files here or

Max. file size: 256 MB.

Does your firm conduct business in a name other than the registered name with RIBO?(Required)

Please provide the full business name(Required)

Does your firm have any branch offices?(Required)

How many branch offices does your firm have?(Required)

Please provide complete address of branch office(Required)

Street Address Address Line 2 City Province Postal Code

Please provide complete address of branch office #2(Required)

Street Address Address Line 2 City Province Postal Code

Please provide complete address of branch office #3(Required)

Street Address Address Line 2 City Province Postal Code

Does the firm operate in any other provinces?(Required)

Does your firm use any trade names?(Required)

Please provide list of trade names(Required)

If yes, is the trade name(s) duly licensed and registered by the provincial authority(Required)

Please provide the most recent renewal of your trade name(s)(Required)

Max. file size: 256 MB.

Does your firm have any affiliates (ex. common ownership, marketing cluster)?(Required)

Please provide list of affiliate names

Does your firm operate any websites?(Required)

Please provide complete list of web addresses(Required)

Does your firm operate a digital platform or program offering insurance on-line?(Required)

Please specify percentage of annual premium volume generated by this sales method(Required)

Please enter a number from 1 to 100.

How does your consumer purchase a policy on-line?(Required)

Does your firm utilize the services of the following:(Required)

Please click on the applicable services above

List software used(Required)

List names of organizations(Required)

List name of services(Required)

Does your firm or part of your firm operate as a call centre?(Required)

Does your firm place any business with wholesalers/MGA?(Required)

Please attach a list of the wholesalers / MGAs your firm places business with.(Required)

Max. file size: 256 MB.

If yes, what percentage of your annual premium volume is placed with a wholesaler/MGA?(Required)

Does your firm have any specialty or niche programs that is only offered exclusively by your firm?(Required)

Please attach list of specialty or niche programs(Required)

Max. file size: 256 MB.

Does your firm deal directly or indirectly with any unlicensed insurance company?(Required)

Please attach list of names(Required)

Max. file size: 256 MB.

If yes, does your firm provide consumers with disclosure that is in compliance with RIBO Reg. 991. s.10?(Required)

If yes, how is disclosure provided?(Required)

Telephone

Email

In Person

Firm Website

Does your firm write any out of province business?(Required)

Are the brokers writing out of province business properly licensed to do so?(Required)

Does your firm charge consumers policy fees, contract fees, administration fees, referrals fees or any fees other than premiums?(Required)

If yes, please attach three examples where you have charged fees including documents.

Max. file size: 256 MB.

Has your firm had any Errors & Omissions (E&O) claims in the last three years?(Required)

If yes, please attach a summary of each claim, the date, and the outcomes if any.(Required)

Max. file size: 256 MB.

Are all members of your firm aware that Negative Option Billing is not permitted?(Required)

Are you aware of any instances of Negative Option billing that have occurred in last 3 years?"(Required)

Please attach details of Negative Option billing occurrence

Max. file size: 256 MB.

Please attach a current listing of your insurance markets by insurer & annual volume, ranging from highest to lowest.(Required)

Max. file size: 256 MB.

Does your firm currently participate in any contests and/or giveaways including charitable donations?(Required)

Please attach details of each program.

Max. file size: 256 MB.

Are brokering services provided by any of the following (please select one)(Required)

Does your firm pay a commission/fee to any company or corporation?(Required)

Does your firm have any non-active firm registrations(Required)

Please attach list of Non-Active Firms(Required)

Max. file size: 256 MB.

Does your firm provide brokering services to other firms?(Required)

Please provide list of registered firms(Required)

Max. file size: 256 MB.

Does your firm outsource any business activity to another entity?(Required)

Please provide details of any outsourced activities(Required)

Max. file size: 256 MB.