New Business Form

This form needs to be completed for any new policy to CIBC: new policy from a new client, a broker of record change or the addition of a new policy to an existing client.

Type of New Policy *
If broker of record change, have letters been submitted to Amanda? *
Are there any Outside Reps (NM Reps, Other) associated with the sale of these plans? *
PLAN INFO
Below is where you enter the information about each line of coverage that the client is putting in place with CIBC. Please fill one section for each line of coverage being put into place.
Plan Types *
Check all applicable plan types being put into place
Plan 1 Renewal/Effective Date *
Plan 1 Renewal/Effective Date
This is the total estimated annual premium for the plan.
Plan 2 Renewal/Effective Date
Plan 2 Renewal/Effective Date
Plan 3 Renewal/Effective Date
Plan 3 Renewal/Effective Date
Plan 4 Renewal/Effective Date
Plan 4 Renewal/Effective Date
Plan 5 Renewal/Effective Date
Plan 5 Renewal/Effective Date
Plan 6 Renewal/Effective Date
Plan 6 Renewal/Effective Date
Plan 7 Renewal/Effective Date
Plan 7 Renewal/Effective Date
TEAM INFO
DO NOT COMPLETE QUESTIONS BELOW!!!!! SCROLL DOWN AND SUBMIT FORM WITHOUT ANSWERING ANY MORE QUESTIONS
COMMISSION DETAILS
DO NOT COMPLETE!!!