RENEWAL APPLICATION AS A SALESMAN

APPLICATION FOR RENEWAL OF PROVISIONAL CERTIFICATIONAS A SALES REPRESENTATIVE
PARTICULARS OF APPLICANT
1. Name

First NameLast Name
2. Current Certificate Number:
3. Payment amount to CBTT:
PARTICULARS OF APPLICATION
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. Provide an explanation why examinations were not completed within the last twelve (12) months
7. Name of Insurer / Brokerage/ Agency for which/with whom the applicant is registered as an Sales Representative
8. Registered Address of Employer.
Instructions for No. 9: The Managing Director/CEO of the Insurer / Brokerage /Agency must have the appropriate delegation/
authority from the Board of Directors to endorse this application by signing and stamping the same Application. Appropriate corporate
governance mechanisms must be implemented to that effect, if not already in place.
10. Name of Salesman - Provisional Only (Block Letters)
- SALES REPRESENTATIVE
  
  (PROVISIONAL-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
- Should be Empty:

APPLICATION FOR RENEWAL OF PROVISIONAL CERTIFICATIONAS A SALES REPRESENTATIVE