Adjuster Application View Adjuster Application PDF To apply, please fill out all relevant information and press submit. Name* First Last Residential Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*FaxMobileEmail* Name of Business (if any) Business Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Business PhoneBusiness FaxHave you ever held an adjusters license anywhere in Canada?* Yes No Please provide information about the license year, class and jurisdiction.*Has any adjuster license held by you ever been suspended or revoked anywhere in Canada? Yes No Have you ever been refused an adjusters license anywhere in Canada?* Yes No Are you currently, or do you plan to engage in any business other than the adjusting business?* Yes No CAPTCHA
