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How to surrender insurance agent code

Application for Surrender of an Insurance Agent Licence Financial Services Commission of Ontario 5160 Yonge Street, Box 85 Toronto ON M2N 6L9 Approved by the Superintendent of Financial Services pursuant to the Insurance Act Instructions --2026

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The document is an application form for insurance agents in Ontario seeking to surrender their insurance agent licence. It outlines the process for submitting the application to the Financial Services Commission of Ontario (FSCO), including requirements for completion, reasons for surrendering the licence, and obligations that remain until the surrender is approved. The form also includes declarations regarding client information and compliance with regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information, including your full legal name, agent licence number, and contact details such as telephone number and email address.
Select the type of insurance agent licence you are surrendering (Life, A&S Only, General) and provide the expiry date.
In the Declaration section, clearly state your reasons for surrendering the licence by selecting one or more applicable options.
Complete any additional questions regarding investigations or outstanding fees as required.
Review all entered information for accuracy before signing and dating the application at the bottom of the form.
Once completed, save your document and send it via mail, fax, or email as instructed.

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