Application for Insurance Adjuster's License

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Personal information on this application form is collected under Sections 345, 346, and 347 of the Insurance Act, as it relates directly to and is necessary for the purposes of applying for a certificate of authority to act as an insurance adjuster. If you have any questions about this collection of personal information, you may contact the Superintendent of Insurance, Financial and Consumer Services Division, 902-368-4550.

Identification

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address