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Contact Information








General Brokerage E-mail (for public)

Owner/Principal Information






(xxx-xxx-xxxx)

(xxx-xxx-xxxx)

(for IBANS related emails)


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  

Young Broker or New to Industry

Please complete questions (a) or (b) if applicable

a) Are you under 40 years of age and interested in becoming a member of the Young Broker Network:

 Y    N

Date of Birth
, 

Would you like to assist with YBN events? If yes, please identify or list any special skills/talents or experience below.


b) Are you over 40 years of age, but new to the insurance industry within the last 5 years, and would like to receive Networking Information:

 Y    N

If yes, please enter your date of hire

General Information




General insurance companies represented in office
 AVIVA  
 Anderson- McTague & Assoc.  
 Antigonish Farmers Mutual  
 BI&I  
 Coast Underwriters  
 ENCON  
 Ecclesiastical Insurance  
 Echelon  
 Economical  
 Gore Mutual  
 Guarantee Company of North America  
 Insurance Company of PEI  
 Intact  
 Kings Mutual  
 Kingsway General  
 Lloyd’s  
 Lombard Canada  
 L’unique General Insurance  
 Marsh Canada  
 Metro General  
 Nordique Insurance  
 Northbridge Insurance  
 Pafco  
 Pembridge  
 Portage La Prarie  
 Portage Mutual  
 Premier Marine  
 RSA  
 Sovereign General  
 Sunderland Marine  
 Totten Group  
 Travelers  
 UCAI  
 Waterloo  
 Wawanesa  
 Wynward Insurance  
 Zurich Canada  

Other:


What percentage of your business is:

Do you sell Life Insurance?
 Y    N

Do you sell Accident and Health?
 Y    N


Please advise who we should contact in your brokerage regarding any accounting inquiries:

    Name
    Phone
    Email

If you participate in IBANS E&O program, please provide the person in your brokerage who is responsible for the E&O Program:

    Name
    Phone
    Email

     Errors and Omissions Policy Expiry



     Fidelity Policy Expiry



Is brokerage owned or controlled (majority interest) by any insurer or financial institution (If yes, firm is ineligible for corporate membership but may be eligible for associate membership - non-voting)
 Y    N

Do agency agreements prohibit the representation of other insurers or groups of insurers (If you can represent only one company you are ineligible for corporate or associate membership)
 Y    N

Has your brokerage completed the Best Practices Program through IBANS
 Y    N

Privacy Information

Do you consent to receive email communications from us?
 Y    N


 Yes   I/We hereby agree to observe strictly the By-laws, Rules and Regulations and Code of Ethics of the Insurance Brokers Association of Nova Scotia (IBANS), as it now is, or may hereafter be constitutionally amended, holding faithfully to the spirit as well as to the letter of said By-laws, Rules and Regulations and Code of Ethics, and also agree that violation by another broker shall not be deemed as in any manner waiving my/our obligations under this agreement.

 Yes   I hereby confirm that the information contained in this application is correct and authorize the Insurance Brokers Association of Nova Scotia (IBANS) to verify the information given with the appropriate sources.

 Enter the text you see:
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