A-354 Form 3 Application for an Insurer's Licence

Application for an Insurer's Licence

Under the Insurance Act, the undersigned Company makes application to a licence to undertake contracts of insurance in Nunavut.

New

Renew

Name of Company

Address of Head Office

City/Town

Name of Chief Agent in Canada

Address of Chief Agent

City/Town

Telephone

Fax

Name of Chief Agent in Nunavut

Address

City/Town

Telephone

Fax

Post Office address to which notice or process is to be forwarded by the Superintendent under Section 267 of the Act:

The Company is authorized by the Order to Insure in Canada Risk dated:

to transact in Canada the following classes of insurance:

What classes do you apply to be licensed for and authorized to undertake in Nunavut?

Type of Company

Joint Stock Insurance Company

Mutual Insurance Company

Cash-Mutual Insurance Corporation

Fraternal Society

Company duly incorporated to undertake insurance contracts not within classes (a) to (d)

Underwriter or syndicate of underwriters operating on a plan known as Lloyd's

Pension Fund Associations

Steps