Printable Forms

Restricted Insurance Agents - Incidental Sale of Insurance Forms


The online application system has recently been enhanced and currently applies to all application categories other than an Amendment to a Restricted Insurance Agent's (RIA) Designated Official, which requires the completion of a paper application.

Refer to the applicable User Guides and/or Amendment Information - When to Notify the Council of Changes before submitting an application to the ICM.



Online Application (*refer to the above)

Employees of Other Entities Application

Application to Change Designated Official

Certificate of Authority Request Form

Agent/Adjuster Licence Reinstatement Form

A Reinstatement Form may only be completed for individuals who have held a licence within the past 12 months and who are wishing to reinstate their licence with the same employer and/or sponsor.

This reinstatement form is only applicable if there are no required changes to your licence.  This form may not be used for transfers or amendments including change of sponsor, agency or business/trade name, where the full application is required.

Mandatory licensing documents, such as proof of continuing education credits, will be required and in some instances proof of valid professional liability insurance (E&O).  Reinstatement is subject to ICM review and approval.

Note that a reinstatement fee of $70.00 is required in addition to the annual licence fee listed on the application form.

Reinstatement Form

Insurance Adjusters Forms

The online application system has recently been enhanced and currently applies to all application categories (New, Amendment, Reinstatement, and Reinstatement + Annual Renewal).

Refer to the User Guides before submitting an application to the ICM.



Application for Provincial Examination

Online Application (*all categories)

Certificate of Authority Request Form

General Insurance Forms

The online application system has recently been enhanced and currently applies to all application categories (New, Amendment, Reinstatement, and Reinstatement + Annual Renewal).

Refer to the User Guides before submitting an application to the ICM.



Application for Provincial Examination

Online Application (*all categories)

Apply for an Upgrade

Certificate of Authority Request Form

 

 

 

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Where You'll Find Us

466-167 Lombard Avenue
Winnipeg, Manitoba
R3B 0T6
  • PHONE:
    (204) 988 6800
  • FAX:
    (204) 988 6801