Complaint Form - Registered Insurance Brokers of Ontario (RIBO) - Ontario's regulator of general insurance brokers"

Complaint Form

Before beginning the complaints process we encourage you to review the Complaints Process so that you are familiar with the steps required to file a complaint. If you still wish to proceed with a complaint after doing so, please complete the Complaint Form below:

Consent
In the course of assisting you with your complaint, we will be capturing information related to your situation. Please review our Consent Disclosure and confirm your consent below.
I hereby authorize the Registered Insurance Brokers of Ontario (RIBO) to disclose the information I have submitted about my complaint, including my personal information, to the individual(s) and/or entity(ies) named in my complaint; to any government ministry, agency, board or commission; to any self-regulatory agency or association; and to any Canadian law enforcement agency as may be required for the purposes of further reviewing or investigating my complaint*
PLEASE NOTE: Declining to authorize the disclosure of information on your behalf will entirely eliminate our ability to assist you with your complaint.
Contact Details
Are you the named insured (policyholder) or are you acting on behalf of someone?*
Your Name*
First Last
Your Email*
Your Phone Number*
Name of Person Lodging Complaint*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please advise if your are a consumer, broker, lawyer or other party*
Please confirm is this complaint is with an individual broker or with a brokerage

Broker Details
What is the full name of the Individual Broker?*
Please confirm the brokerage they work for
Hidden
Employer Brokerage License
Brokerage Details
What is the name of the brokerage this is related to?
Hidden
Brokerage License
What is the name of the broker you dealt with?*
Incident Details
Brokerage Location
City Province
Which insurance company is this related to?*
When did the incident occur?*
MM slash DD slash YYYY
What Type of Insurance is this related to?*
Please provide specifics on the type of insurance this is related to*
Policy Number(s)

Consent

Contact Details

Broker Details

Brokerage Details

Incident Details

Complaint Details