Thank you for your interest in BNQ Financial. Below is some mandatory information that we must collect for compliance purposes. Once we have these details, we will prepare an On-Boarding Agreement that will be sent over for signature. Please do not hesitate to reach out at any point in the process with any questions that you might have. We are looking forward to chatting further with you.

Your Preferred Start Date *

Full Legal Name *

Gener *

Female

Male

Other

Name to Whom Commission Would be Processed (either a company or an individual) *

If applicable, Incorporation Date of Company To Whom Commissions Will Be Processed

If applicable, CRA Business Number of Company To Whom Commissions Will Be Processed

Province of Agent\Broker License Registration *

Address

Street Address *

City

State

Country

Postal code

Date of birth *

Social Insurance Number (for Processing Annual T4As) *

Phone *

Email *

Banking Information (attach VOID cheque)

Bank Name

Bank Transit Number

Bank Institution Number

Bank Account Number

Emergency Contact Name *

Emergency Contact Phone Number *

Employment History for the past 5 years, Including self-employed and unemployed period: *

Previous Names You Are\Have Been Known By

Have you been licensed or registered under another financial, security or mortgage regulator in any province in Canada? If so, please indicate if registration is still active and the province: *

Have you ever had a license or registration refused, or been disciplined by a regulator, or had your license suspended or cancelled by any regulatory body in Canada? If so, please provide the details and also indicate if all has been resolved and when the judgment was satisfied:

Have you, or are you: - Currently subject to any criminal charges or indictments? - Been convicted of any criminal offence under any law in any province? - Been subject to bankruptcy proceedings? - Had a criminal or civil judgment rendered against you personally in any province? - Currently under investigation by any law enforcement or regulatory agency? If the answer to any of the above questions is yes, please provide an explanation.

Please provide 3 references, 2 professional and 1 personal. Please include name, email and phone. *

Comments\Notes

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