Office
Title/Position
Honorific== select == Mr. Ms. Miss Mrs. M. Mme Dr. Hon.
First Name
Last Name
E-mail (for RCCAQ related emails)
Certificate no.
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
Address
City
Prov/State== select == AB BC MB NB NL NS NT NU ON PE QC SK YT Other
Postal/Zip Code
Country== select == Canada United States
Phone
Mobile
Fax
General Brokerage E-mail (for public)
Website
AMF no.
Language of communication French English
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
Expiry date of your group health insurance
Yes - I hereby agree that information provided herein be shared between Courmark, RCCAQ and their partners & vice versa.
Name of your banner or group== select == Assurancia AssurExperts Courtiers-Unis Groupe Jetté Groupe Ultima Intergroupe Intergroupe & AssurExperts
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?
Claims Adjustment Damage insurance Financial planning Group insurance of persons Group savings plan brokerage Insurance of persons Investment contract brokerage scholarship plan brokerage
== select == 0 - 499 999 500 000 - 999 999 1 000 000 - 1 499 999 1 500 000 - 1 999 999 2 000 000 - 2 999 999 3 000 000 - 3 999 999 4 000 000 - 4 999 999 5 000 000 - 7 499 999 7 500 000 - 9 999 999 10 000 000 - 14 999 999 15 000 000 - 19 999 999 20 000 000 - 24 999 999 25 000 000 - 49 999 999 50 000 000 - 99 999 999 100 000 000 and more
Who can view your profile? members only administrators only
I'd prefer receiving the Liaison magazine in its virtual version Y N