New Broker Intake Form Because you’ll need to complete the form in one sitting, please be prepared with the following which will need to be uploaded to the form: Copy of valid BCDL Criminal record check – new registrations only Completed course certificate(s) – new registrations only Statutory Declaration – for applicants currently registered in another province (this must be signed in the presence of a lawyer or notary public) Full Legal Name * Mailing Address * Mailing Address Mailing Address Mailing Address City City Province Province Postal Postal Mailing Address Date of Birth * Place of Birth * Citizenship * Previous Employer * Email * Cell Phone * Office Phone Fax SIN * Registration Type * New Registration Transfer within BC Transfer other province FICOM Number You may skip this field only if transferring your license from another province. If you are human, leave this field blank. Next