Life and Accident & Sickness Insurance Forms

The online application system has recently been enhanced and currently applies to all application categories (New, Amendment, Reinstatement, and Reinstatement + Annual Renewal).

Refer to the User Guides before submitting an application to the ICM.

*Life and Accident & Sickness Insurance Applications are Authorized by (sponsored by) the sponsoring insurance company

Online Application for Provincial Examination

Online Application (*all categories)

Supervision Certificate

Certificate of Authority / Non-Resident Endorsement Request Form

Supervision Statement


Where You'll Find Us

466-167 Lombard Avenue
Winnipeg, Manitoba
R3B 0T6
  • PHONE:
    (204) 988 6800
  • FAX:
    (204) 988 6801