Current Page 1 Page 2 Preview 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