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GENERAL INFORMATION






(for RCCAQ related emails)


Do you consent to receive email communications from us?
 Y    N

Date of birth

Sex
 Male    Female

Role (check all that apply)
 Manager  
 Broker  
 Staff  
 Administrator  
 Administrator staff  









(for public)



Language of communication
 French    English

ADDITIONAL INFORMATION

Have you used the RCCAQ training service?
 Broker 101-102  
 Web training  
 On-site training  
 Pre-recorded Video Training  

Expiry date of your professional liability insurance

Name of the insurer

Expiry date of your directors and officers liability insurance

Name of the insurer

Expiry date of your group health insurance

Name of the insurer

 Yes  - I hereby agree that information provided herein be shared between Courmark, RCCAQ and their partners & vice versa.

COMPANY PROFILE


Is your firm a shareholder of a banner?
 Y    N
If yes, which one?

If your firm affiliated with an insurer (shareholder)?
 Y    N
If yes, which one?

WHAT ACTIVITIES ARE YOU LICENSED TO PERFORM ACCORDING TO AMF

 Claims Adjustment  
 Damage insurance  
 Financial planning  
 Group insurance of persons  
 Group savings plan brokerage  
 Insurance of persons  
 Investment contract brokerage  
 scholarship plan brokerage  

VOLUME OF PREMIUM IN $

Who can view your profile?
 members only    administrators only

I'd prefer receiving the Liaison magazine in its virtual version
 Y    N

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