Formulario para un seguro automovilistico

Financial Services
Commission
of Ontario

Commission des
services financiers
de l’Ontario

INSURANCE ADJUSTER APPLICATION
FEE

DATE APPLICATION
MADE

APPLICATION FOR

$75

Licence to Act as an Insurance Adjuster

New

PREVIOUS
LICENCE NO.

Renewal

For FSCO Use Only

License No.
Date Issued:
Expiry Date:
Approved By:
Fee Payment

Attachments

PART A:IDENTIFICATION INFORMATION
Personal information requested on this Application is collected under the authority of the Insurance Act, R.S.O. 1990, C.I.8, as
amended. This information will be used to determine if an applicant is qualified to have a licence issued or renewed. Pursuant to
the Freedom of Information and Protection of Privacy Act, 1987, the personal information requested will be used toverify the
information supplied from any source which may have information pertinent to the information provided. Any questions about this
collection may be directed to the Senior Manager, Registration.

PLEASE PRINT OR TYPE ALL INFORMATION
Application on behalf of:
(Legal Name in Canada)

(Last Name)

(First Name)

(Middle Initial)

Date of Birth:
(Day)

(Month)

(Year)

MailingAddres:
City

Province

Postal Code

Contact Name:

Telephone No.

Fax No.

E-mail Address

Position:

Name of Adjuster or Adjusting Firm now employed by:
1.

This application consists of six parts, Parts A to F. Parts C and F are required to be completed by NEW applicants only.

2.

If you have any questions about this application, contact your sponsoring company. Forgeneral information, you may contact the
Agents and Adjusters Voice Menu Response System at (416) 250-9209 [Toronto] and at (1-800) 263-0541[outside Toronto]. You
may also obtain information at our Internet address of www.fsco.gov.on.ca or by writing the Financial Services Commission of
Ontario, Licensing and Enforcement Division, Agents and Adjusters Section, 5160 Yonge Street, Box 85, North York,Ontario, M2N 0L9.

3.

Incomplete applications - those that are missing any of the items below - will be returned without processing.
F Required signatures
F Required fee - make all cheques and money orders payable to the
“THE MINISTER OF FINANCE”

F Responses to all required parts and questions
F Relevant attachments and supporting documents

Please be aware, that the deposit of acheque or money order does not automatically mean that the individual is licensed.
Following good management practices, all cheques are deposited on receipt. If an individual does not wish to renew their
licence, a refund cheque will be issued upon request.
4. If you are adjusting, using a corporation/partnership, or name other than your personal name, that corporation/partnership or
businessname must also be licensed with the Financial Services Commission of Ontario. It is an offence to carry on business with
a name not licensed by FSCO.
5. Initially, the applicant will be granted a Letter of Authority followed by a Probationary Licence.
Letter of Authority- within 30 months the applicant must complete four courses through the Insurance Institute of Ontario, namely:
F Course 11-Principles and Practices of Insurance or General Insurance Essentials FCourse 12- Insurance on Property, Part I
F Course 14 - Automobile Insurance
F Course 17- Claims
Probationary Licence - (for those candidates with an AIIC or FIIC, no additional courses are required; you can appear before the
Qualifications Board) otherwise you have 30 months to complete four more courses through the InsuranceInstitute of Ontario in
addition to the four mentioned above prior to appearing before the Qualifications Board, namely:
F Course 13- Insurance Against Liability
F Course 32- Bodily Injury Claims
F Course 33- Insurance on Property Part II
F Course 46- Claims II
6. It is your responsibility to ensure that your license is always in force.
(04-00)

Providing false, misleading or...