Insurance Brokers Association of Ontario Application for Registration for Basic Brokers Preparation Course (Working under supervision) Surname First Name Title



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Insurance Brokers Association of Ontario

Application for Registration for

Basic Brokers Preparation Course (Working under supervision)

Surname _____________________________________ First Name ________________________________________

Title Mr. ________ Mrs. ________ Miss ________ Ms. ________

Street Address _____________________________________________________________________________________

City _____________________________ Postal Code ________________

Home Phone ______________________ Cell Phone_________________________

Email Address ______________________________________________________________________________________

Date of Birth Year __________ Month _________________ Day __________

Student # _________________________

Course Date: Monday, May 8, 2017 – Friday, May 12, 2017

8:30 am – 4:30 pm



Exam Date: Friday, May 12, 2017

Course Fee: $499.00 Payable by April 21st for Registration to Mohawk College of Applied Arts and Technology. Payments will be accepted at The Square. Confirmation of payment via receipt from the college is to be dropped off to Nansi Alkhassi at the M Wing with your complete Registration Package.

Exam Fee: $180.00 Payable by April 21st to Registered Insurance Brokers of Ontario by Certified Cheque/Money Order. Payment of Exam Fee is to be dropped off to Nansi Alkhassi at the M Wing with your complete Registration Package. CHEQUES MUST BE CERTIFIED.

BASIC BROKERS PREPARATION COURSE (Working under supervision)
Course Lectures: Monday, May 8, 2017 – Friday, May 12, 2017

8:30 am – 4:30 pm


Thank you for your interest in the above course. As enrolment is limited, registration will be accepted on a “first come” basis.
**In addition to the course fee, the student will be responsible for the Examination fee of $180.00. A separate cheque in the amount of $180.00 and made payable to the Registered Insurance Brokers of Ontario accompanied by two passport photos must be submitted by Friday, April 21st, 2017 to Nansi Alkhassi at the M-Wing.
After completion of the registration form accompanied by your cheque, you will be notified of the continuation of the course when sufficient enrolment has been obtained. If there is insufficient enrolment and the course is cancelled, a full refund will be issued. Applications will only be accepted when returned to Nansi Alkhassi.
**You must submit a “Criminal Record Verification” to RIBO before the course commences. You can bring this form to class on the first day to be submitted with your application. You will not be allowed to be registered until RIBO receives this form. You can obtain this form from your local police detachment. As it can take up to 3 weeks to obtain the form, please proceed to obtain the form as soon as possible. Students MUST go to the police service in their home community.  For example if a student lives in Grimsby and comes to Mohawk they must go to Niagara Regional Police, not Hamilton.

Completed Registration Package Checklist:

INCOMPLETE PACKAGES WILL NOT BE ACCEPTED



DEADLINE: Friday, April 21, 2017

  • Print off “Student Item Request Form,” and take it with you to pay the Course Fee of $499.00 at The Square (C102) – Include the receipt of payment in your completed Registration Package

  • Completed “Application for Registration for Basic Brokers Preparation Course”

  • Certified Cheque/Money Order of $180.00 to Registered Insurance Brokers of Ontario

  • Criminal Record Verification Check (Or receipt if you are unable to attain it right away)

  • 2 Passport Photos (SIGN THE BACK OF EACH)



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