Prospective Broker Application

To begin the application process of becoming a Chubb-appointed broker, we would like to know more about your business.

* Indicates required field

About your brokerage

Brokerage Name

Business Address

City

Province

Postal Code

Brokerage Business Email Address

Brokerage Phone Number

Brokerage Website

Year Brokerage Formed

Is your brokerage currently accessing Chubb through another broker or aggregator?*

Yes No

If Yes, please list

Principal(s) Name (comma separated)

Principal(s) Email (comma separated)

What line(s) of business are you seeking a Chubb appointment for?

Commercial Lines

Personal Lines

Accident & Health

Are you able to commit to writing $25,000 or more in new business within the next 12 months?*

Yes No

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