Become A Broker

If you would like to become a broker for TCIM then please either fill out the following online form or download this PDF, fill it out and mail it to us. We look forward to working with you.

GENERAL INFORMATION

Broker Name: *

Street *

City

Province

Postal Code

Phone # *

Fax #

E-mail *

Website (if applicable)
www.

Would you prefer that we contact you: *

by email

by fax

CONTACTS

Agency Principal *

e-mail *

Contact(s) for Broking
*

e-mail
*

Contact for agency accounting

e-mail

Number of Employees *

SPLIT PERCENTAGES

Commercial Volume $ *

Commercial % *

Personal % *

OTHER INFORMATION

Insurers you currently use: *

Wholesaler(s) you deal with: *

Classes of business or accounts you would like to target:

Date

Month *

Day *

Year *
20

CONDITIONS

Whether collected or not, you agree to remit payments to be received in TCIM office by the 30th of each month for that statement month, based on TCIM statement and accompanied by a detailed listing of items being paid.
You will comply with Privacy Act rules.
You will maintain Errors & Omissions insurance in accordance with provincial regulations.