iccrc-crcic Errors and Omissions Coverage

iccrc-crcic iccrc-crcic

Application - Errors and Omissions Insurance for the Members of the Immigration Consultants of Canada Regulatory Council September21, 2017 to July 1st, 2018.

For claims assistance and procedures, please view our easy to read pdf document.

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* Required Fields

Applicant Information

*

Billing Address

Mailing Address if different from billing address

Applicant History

Are you RENEWING your Errors & Omissions Insurance under the ICCRC Program?

*

If you chose "No" and are therefore purchasing coverage for the first time please answer the two following questions.

In the past, has the Applicant or any of his/her employees ever been the recipient of any allegations of professional negligence in writing or verbally?:

Is the Applicant or any of his/her employees aware of any facts, circumstances or situations which may reasonably give rise to a claim, other than as advised above?

If yes, please attach details.

WITHOUT LIMITATION OF ANY OTHER REMEDY AVAILABLE TO THE INSURER, IT IS AGREED THAT IF THERE BE KNOWLEDGE OF ANY SUCH FACT, CIRCUMSTANCE OR SITUATION, ANY CLAIM OR ACTION SUBSEQUENTLY EMANATING THEREFROM IS EXCLUDED FROM COVERAGE UNDER THE PROPOSED INSURANCE.

Limits Requested:

Limit Per Claim/Per
Policy Period
Deductible Premium (incl $37 Fee) Taxes Total
$1,000,000 $500 $250 $20.00 $270.00
All funds payable in $ CDN and are 100% earned and non-refundable.

* Are you ordinarily a resident of Ontario?

Subject to a policy aggregate of $7,500,000.

APPLICANT CONSENT TO THE TRANSMISSION OF THE INFORMATION CONTAINED IN THE APPLICATION FORM

I hereby acknowledge that the information collected in the Application form is acquired by my insurance broker to be transmitted to ENCON Group Inc. for the sole purpose of obtaining an insurance policy, and will be kept confidential.

Moreover, I authorize ENCON Group Inc., its insurers or service providers to:

  • conduct verification, using outside sources, of the information contained in the Application form, in attached documentation and in subsequently provided documentation;
  • in the event of a claim, transmit the submitted and verified information to loss adjusters, lawyers or other similar offices for the purposes of investigating, defending, negotiating or settling any claims, as required.

For more information on ENCON's privacy policy, please contact .

DECLARATIONS AND SIGNATURE

The undersigned Applicant for this insurance declares that, to the best of his/her knowledge and belief, the statements set forth herein are true and correct and that reasonable efforts have been made to obtain sufficient information to facilitate the proper and accurate completion of this Application form. The undersigned further agrees that if any significant change in the condition of the Applicant is discovered between the date of this Application form and the effective date of the policy, which would render this Application form inaccurate or incomplete, notice of such change will be reported immediately in writing to the Insurance Manager.

Although the signing of this Application form does not bind the Applicant to purchase the insurance, the undersigned Applicant agrees that this form and the information furnished pursuant hereto shall be the basis of the contract should a policy be issued and this form will become part of the policy.

In the event of a claim or circumstance, I agree and consent to any information and documentation relating thereto to be released and disclosed to Immigration Consultants of Canada Regulatory Council (ICCRC) for the purpose of enabling ICCRC to carry out its responsibilities and functions under the letters patent, bylaws and regulations of ICCRC

By submitting this form and making payment the applicant agrees to all terms and conditions.

Please select Buy Now to submit the application with credit card payment. Select Print Page to send application along with a cheque payable to Smith Petrie Carr & Scott Insurance Brokers Ltd.

Contact Information
Telephone 613-237-2871
Facsimile 613-237-1179
Toll Free 877-432-5118


www.spcs-ins.com