RENEWAL APPLICATION AS A SALESMAN

APPLICATION FOR RENEWAL OF CERTIFICATE OF REGISTRATION AS A SALESMAN
1. Name

First NameLast Name
2. Current Certificate Number:
3. Payment amount to CBTT:
PARTICULARS OF APPLICANT
1. Salutation
1.a. Name

First NameSurname
2. Address: Home
2.a. Mailing (if different from above)
3. Telephone Number Home
3.a. Telephone Number Work
3.b. (Mobile)
Format: (000) 000-0000.
4. E mail address
example@example.com
5. Nationality
6. Occupation
Instructions for No. 7: Please enclose CPD return and the written verication from the approved educational institution withthis application for renewal of registration. The CPD return must be endorsed by the Insurer/Brokerage/Agency with whichyou are employed. If your CPD hours were prorated, enclose evidence to support a proration in accordance with regulation12(3) of the Regulations.
(a) Have you met the CPD requirements for the period?
(b) If No, was a prorated CPD granted?
(c) If No, was a prorated CPD granted?
(d) If more than 12, indicate the number of credits carried forward
(e) Indicate the name of the Approved Educational Institute(s) and the reason for prorating in accordance with regulation 12(3)of the Regulations..

(f) Indicate the CPD points earned in the following areas:

Rows	Minumum 12 Hrs
Insurance Business:
Ethics:
Laws and Regulations:
Other (Specify):

8. Are you a significant or controlling shareholder, director, officer or other employee of a brokerage or insurer?
If Yes, please give details/other employment.
Whereas an agent earns CPD in excess of the minimum yearly requirement referred to in regulation 12(1) of the Regulations, up to two of the excessCPD hours may be carried into the following CPD year. (See Regulation 13(3)).2 In addition to CPD on insurance business, ethics and legislation, agents may undergo CPD in other areas relevant to the business they carry on (e.g.training on sales and customer relations, new technological developments, etc.
PARTICULARS OF APPLICATION
9. Name of Insurer / Brokerage/ Agency for which/with whom the applicant is registered as an Sales Representative
10. Registered Address of Employer.
Instructions for No. 11: The Managing Director/CEO of the Insurer / Brokerage /Agency must have the appropriate delegation/authority from the Board of Directors to the endorse this application by signing and stamping the same. Appropriate corporategovernance mechanisms must be implemented to that effect, if not already in place
- Instructions for No. 16: The Managing Director/CEO of the Insurer must have the appropriate delegation/authority from the Boardof Directors of the Insurer in relation to Agency matters to endorse this application by signing and stamping this form. Appropriatecorporate governance mechanisms must be implemented to that effect, if not already in place.
- Instructions for No. 17:
  
  If the Agency is the applicant –
  
  (a) the signature of an Agent need not be included; and
  
  (b) the Managing Director/CEO must have the appropriate delegation from the Board of Directors of the Agency to sign andstamp this form. Appropriate corporate governance mechanisms must be implemented to that effect, if not already inplace.
  
  For Agent renewal applications, the Agency, through its Managing Director/CEO on behalf of the Board of Directors, must have theappropriate delegation or authority to endorse this application by signing and stamping this form. Appropriate corporate governancemechanisms must be implemented to that effect, if not already in place.
  
  17. I certify that to the best of my knowledge and belief all of the information given in this application is true and correct.
- 11.a. Name of Managing Director/CEO of the Agency(Block Letters)
- 11.b. Name of Salesman (Block Letters)
- SALES REPRESENTATIVE
  
  (RENEWAL)
  
  CHECKLIST
- TO BE COMPLETED BY APPLICANT
  
  SUPPORTING DOCUMENTS:
- Please check the list to ensure all documents are attached to this application
- The Company verifies that due diligence3 was conducted and all questions on the application form were com
- 12. Name
  
  First NameLast Name
- Should be Empty:

APPLICATION FOR RENEWAL OF CERTIFICATE OF REGISTRATION AS A SALESMAN

PARTICULARS OF APPLICATION

SALES REPRESENTATIVE

(RENEWAL)

CHECKLIST

TO BE COMPLETED BY APPLICANT