New Individual Sign-up

Honorific
== select == Mr. Ms. Miss Mrs. Dr.

First Name

Middle Name/Initial

Last Name

E-mail (for IBAN related emails)

Have you completed your CAIB?
 Y    N

Are you a licensed broker?
 Y    N

Level of licensing
== select == Level 1 Level 2 Level 3

Please include any other insurance designations you possess

Have you ever been a member of IBAN?
 Y    N

Property and Casualty Organization where you are currently employed

Briefly Explain why you would like to Join the Insurance Brokers Association of NL

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

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

 Yes   I/we hereby agree to observe strictly the by-laws, rules and regulations of the Insurance Brokers Association of Newfoundland & Labrador (IBAN), 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 also agree that violation by another broker shall not be deemed as in any manner waiving my/our obligations under this agreement.

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