Broker Application

Need Some Help? Or Prefer a Download

Should you have any questions, please contact us.
If you prefer pen to paper, download our fillable Broker Application Form and spreadsheet.

Broker Application Form

Spreadsheet

Broker Application Webform

Registration Type

Register As (Required)

New User Account (Existing Brokers)

Brokerage / Branch Details

Branch Address

User Details

New Brokerage Application

Brokerage Details

Head Office Details

Head Office Address

List of Branches

Branch Details

Maximum file size: 32MB

Accepted file types: xlsx, xls

Contracts, MGA's & Wholesalers

List all contracts with insurance companies

Insurance Company

List all MGA’s & Wholesalers you do business with

Points of Contact

Commercial Lines

Personal Lines

Overall Contract Relationship

Electronic Data Transmission Contacts

Bulletins

Product Training

Canada’s Anti-Spam Law (CASL) requires consent for our electronic messages.

 I consent to Taycon Risk sending emails to my Brokerage.

Platform User Logins

DRUM is our self-serve platform where you can quote & issue your documents in real time.

For all brokerage accounts, we require you to provide a *General email address. This email address will be sent a copy of all policy activity (for all users). This serves as an excellent audit trail for brokerage management. (Consider – taycon@abcbrokerage.com).

Each individual user’s login will be their company email. Every user can view all brokerage transactions. The platform records activity by individual user.

When a user enters a policy transaction, the individual user will receive the document in their company email and the brokerage will also receive an email in the *General email address provided below for the Brokerage.

Required for general policy deliverance

User Accounts

Maximum file size: 32MB

Accepted file types: xlsx, xls

Errors & Omission Coverage

Has there been any E&O claims in the past 5 years?

Licencing - List Current Licences

Has the Brokerage had any license(s) suspended, terminated or been fined?
Has the Brokerage or any licensed individual representing the Brokerage been reprimanded by a Regulator in the past 5 years?

Acknowledgement

I declare that I am authorized to disclose the information in this application and authorized to request a new Broker Code on behalf of the legal entity listed in this application.