License Renewal Form

PERSONAL INFORMATION

DECLARATION AND SIGNATURE OF APPLICANT

I confirm that:

You are required to submit your documentation confirming completion of your CE requirements for all the cycles of non-renewal.

Click or drag files to this area to upload. You can upload up to 20 files.

FIT AND PROPER REQUIREMENT

Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?, Insurance Regulator, FINRA, etc.)?

Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?

Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?

Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?

If you have answered “Yes” to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action taken. Any information you provide will be collected, stored and used in accordance with applicable law and our privacy policy and will be shared with the Designation Ethics Committee to determine your suitability for the designation.

* “Criminal offence” excludes an offence (i) under a provincial regulatory statute, such as the Highway Traffic Act, unless the provincial statute is specifically listed above and unless the provincial conviction involved an offence of dishonesty or theft, such as perjury or subornation of perjury, false statement, fraud, embezzlement, or false pretense, or any other offense the commission of which involves some element of deceit or untruthfulness, and (ii) an offence punishable by summary conviction only that is not an offence of dishonesty or theft.

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