Don't forget to register for the 2023 Atlantic Brokers Convention October 11 - 12 in Charlottetown, PEI
Brokerage
Address
City
Prov/State== select == ==Canada== AB BC MB NB NL NS NT NU ON PE QC SK YT ==USA== AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MR MS MT NC ND NE NH NJ NM NN NV NY OH OK OR PA PL PO PR RI SC SD TN TT TX UT VA VI VT WA WI WV WY
Country== select == Canada United States --- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Postal/Zip Code
Phone
Fax
General Brokerage E-mail (for public)
Website
First Name
Last Name
Former Surname
Title/Position
E-mail (for IBANB related emails)
Personal E-mail
Are you a licensed broker? Y N
Role (check all that apply) Manager personal Lines Manager commercial lines Producer Customer Service Representative Branch Manager Accounting contact PD contact other
Year of birth== select == 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Please indicate if you are 40 years of age and under and would like to become part of our Young Broker Network. If so, please enter your birthday Y N
Date of Birth(month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec ,
Name of Insurance Company sponsoring your license
How many general insurance companies does your firm contractually represent?(Exclude life insurance companies & facility carrier). Please list these companies.
Is the only business of the firm that of an insurance broker? Y N If no, please explain
Does your firm hold a trust account? Y N
Details of your Errors & Omission Insurance:
Carrier Policy Number Effective Date
Please indicate percentage, if any, of brokerage shares which are owned by a financial institution (includes insurance company)
Have you or any employee of your firm ever had an insurance license suspended or revoked? Y N If yes, please provide details
Provide a brief history of your Brokerage
"The undersigned confirms to the IBANB that, with respect to any information provided, the undersigned has obtained the appropriate consent of the applicable individual to release that individual's information to IBANB." Yes - I, the undersigned, confirm all information to be true and accurate.
Do you consent to receive email communications from us? Y N
I HEREBY CERTIFY that the applicant insurance brokerage is owned by a "Financial Institution" (includes Insurance Company) as defined by IBANB Bylaws 1.1 revised April 2009 1.1 "Financial institution" (a) a bank; (b) a body corporate to which the Trust and Loans Companies Act (Canada), as amended from time to time applies; (c) an association to which the Co-operative Credit Associations Act (Canada), as amended from time to time applies; (d) an insurance company or fraternal benefits society to which the Insurance Companies Act (Canada), as amended from time to time applies; (e) a trust, loan or insurance corporation incorporated by or under an Act of the legislature of a Province; (f) a co-operative credit society incorporated and regulated by or under an Act of the legislature of a Province; and (g) a credit union under the Credit Unions Act, Loi sur les Caisssies Polulaires or similar legislation. Read More Y N
1.1 "Financial institution"
(a) a bank;
(b) a body corporate to which the Trust and Loans Companies Act (Canada), as amended from time to time applies;
(c) an association to which the Co-operative Credit Associations Act (Canada), as amended from time to time applies;
(d) an insurance company or fraternal benefits society to which the Insurance Companies Act (Canada), as amended from time to time applies;
(e) a trust, loan or insurance corporation incorporated by or under an Act of the legislature of a Province;
(f) a co-operative credit society incorporated and regulated by or under an Act of the legislature of a Province; and
(g) a credit union under the Credit Unions Act, Loi sur les Caisssies Polulaires or similar legislation.
I HEREBY CERTIFY that the applicant insurance brokerage is "controlled" by a Financial Institution (includes Insurance Company) as defined by IBANB Bylaws 1.2 revised April 2009
1.2 (1) Control of Brokerage – A Brokerage is “controlled” by a financial institution if the Brokerage is:
(a) a corporation in which the financial institution, its subsidiaries or affiliates holds the controlling shares for the election of directors of the corporation;
(b) a general partnership, there are one or more partners consisting of a financial institution, its subsidiaries or affiliates;
(c) a limited partnership, there is a limited or general partner consisting of a financial institution, its subsidiaries or affiliates, or
(d) an individual, the individual is an employee or agent of a financial institution or its affiliates.
1.2 (2) Notwithstanding subsection (1), a Brokerage which appears to be controlled by a financial institution shall not be deemed to be controlled by a financial institution if the Brokerage can establish, to the satisfaction of the Board acting in its sole discretion, that it is independent and free of any controlling interest. Any such determination by the Board shall be binding upon the Brokerage.
I CONFIRM the applicant insurance brokerage/broker is applying for membership as a == select == voting non-voting member in accordance to Bylaw Part 2 Article 2.1 Membership Categories.
2.1 Membership Categories – Membership in the Association is voluntary. The categories of membership in the Association are as follows:
1. Member – A Brokerage, whether a corporation, partnership or an individual, including their Subsidiaries, carrying on business in New Brunswick and which satisfy the criteria contained in the Membership Application Form, being Appendix A to these by-laws, may become a member of the Association. A Brokerage is entitled to only one membership for the Brokerage and its Subsidiaries, which membership will be in the name of the Brokerage, regardless of how many corporations, partnerships, individuals, employees or offices are represented by the Brokerage and its Subsidiaries.
2. Associate Member – The following qualify as Associate members:
(a) Persons who qualify for the designation of C.A.I.B., C.P.I.B. or C.C.I.B. and hold a valid “other than life” brokers license to transact general insurance under the Insurance Act of New Brunswick as an employee of a brokerage which is not a member and who satisfy the criteria contained in the Association’s Membership Application Form, being Appendix B to these by-laws;
(b) In the discretion of the Board, any other person, business or Brokerage not able to meet the qualifications of an Associate member under paragraph (a) or do not come within the definition of Brokerage, but satisfy the criteria contained in the Associate membership Application Form being Appendix A to these by-laws.
NOTE: Associate Members have no voting rights and are prohibited from using the Broker Identity Program logos and slogans of the Insurance Brokers Association of New Brunswick and the Insurance Brokers Association of Canada.
3. Life Member – The Board may, in their sole discretion, grant Life Membership to a broker who has been active as an insurance broker for at least 25 years as a member of the Association or has rendered outstanding service to the Association. The Board may, in their sole discretion, revoke any such membership at any time. No membership fees are payable by life Members and they have no voting rights.
4. Honourary Member – The Board may, in their sole discretion, grant Honourary Membership to Past Presidents of the Association who are not engaged in the insurance business. The Board may, in their sole discretion, revoke any such membership at any time. No membership fees are payable by Honourary Members and they have no voting rights.
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