CLICK TO PRINT Canadian Professional Insurance Broker Application for Registration

1. NAME __________________________________________________________________

PHONE # _________________________ FAX # ___________________________________

2. EMPLOYER _______________________________________________________________

3. BUSINESS ADDRESS ________________________________________________________

CITY/TOWN ________________________________ POSTAL CODE ______________

4. PREFERRED MAILING ADDRESS:

____________________________________________________________________________

5. I (my firm) is a member in good standing of the Insurance Brokers Association of Newfoundland. Yes No While membership in the provincial brokers' association is not a pre-requisite of this course, membership IS required for the use of the CPIB designation.

6. I am a licensed general insurance broker:    YES   NO

7. Please indicate the stream you will be taking: Personal Lines Commercial Lines Management

8. Please indicate the course you wish to register for:

Law & Ethics for the Canadian Insurance Broker

Law & Ethics for the Canadian Insurance Broker is the only mandatory course available for the Winter 2000 semester

9. STUDY METHOD: Discussion Group Correspondence Self-Study On-line

10. I have enclosed my cheque payable to IBAN for $_____________

11. If I am successful in the examinations, and am awarded use of the designation of "Canadian Professional Insurance Broker", I hereby certify that I agree to abide by such requirements as may be established by the Insurance Brokers Association of Canada and the Insurance Brokers Association of Newfoundland from time to time as they see fit.

DATED ________________________ SIGNED ______________________________________

PLEASE RETURN THIS FORM ALONG WITH YOU CHEQUE TO:

Jacquie Berkshire P.O. Box 275 Mount Pearl, NL A1N 2C3 Tel (709) 726-4450 Fax (709) 754-4399

IBAC PROFESSIONAL DEVELOPMENT DESIGNATIONS

TERMS OF REFERENCE

(1) The right to obtain an IBAC designation will be restricted to successful candidates who are employed by a property and casualty insurance brokerage and are members in good standing, as at the time of the granting of such IBAC designation, of a member association which is and continues to be a member of IBAC. (2) At the sole discretion of IBAC and member associations, non-members and/or non-brokers shall be allowed to complete any program offered by IBAC, and upon successful completion, such non-members and/or non-brokers will be entitled only to Certificates of Completion. (3) The right to use and maintain any IBAC designation granted by IBAC shall only continue while such person is employed by a property and casualty insurance brokerage, acceptable to the IBAC Board of Directors, while that brokerage continues to be a member in good standing of a member association which itself is a member in good standing of IBAC. (4) A licensed property and casualty insurance broker, having earned a Certificate of Completion or an IBAC designation, who is an employee (not a principal) of a property and casualty insurance brokerage that is not a member of a member association of IBAC, will be allowed to obtain membership or associate membership with the appropriate member association of IBAC, failing which that person's right to use such IBAC designation will be terminated. (5) The granting of member and/or associate member status is at the discretion of the member association and shall be in accordance with, and subject to, the applicable member association's by-laws, rules, regulations and guidelines. (6) The administration of membership and associate membership is the responsibility of the applicable member association. (7) All candidates must be granted permission to use IBAC designations through specific election by the IBAC Board of Directors. (8) Employees of IBAC or its Member Associations, who have successfully completed the CAIB examination requirements, may hold an IBAC designation as long as they remain so employed. April 2001