Skip to content
Information Center > Public Forms > Forms - Insurance Intermediaries

Forms - Insurance Intermediaries

Original signed forms are required to be submitted to the Insurance Authority ("IA").

Licence Application Forms

Form Form Details View
A1 Individual Licence Application (Individual Insurance Agent/TR(A)/TR(B))

Important Notes:
  1. Please read "Notes on Application for Insurance Intermediary Licence" before completing Form A1.
  2. Before submission, please also check the Register of Licensed Insurance Intermediaries to ensure the applicant is not holding an active licence with the Insurance Authority.  
  3. If the applicant is holding an active licence and he/she/it is not going to change his/her/its licence type under a new appointment, then a Form N2 should be used to notify the IA of the new appointment instead of Form A1.  Please note that a new appointment of an active licensee is NOT a new application. 
 pdf Updated
pdf
A2 Online Portal – Application for Opening of Supervisor Account 

Authorized insurers, licensed insurance agencies and licensed insurance broker companies are required to submit an originally signed Form A2 to apply for opening of a Supervisor Account of Insurance Intermediaries Connect for e-submission of applications for individual licence. For more information about the Insurance Intermediaries Connect, please refer to the following user guides:
  • User Guide of the Insurance Intermediaries Connect for Individual Applicants to Submit an Individual Licence Application
  • User Guide of the Insurance Intermediaries Connect for Principals
  • Demonstration Video - Opening of Supervisor Account of the Insurance Intermediaries Connect
  • Demonstration Video – Activation of Individual Account 
  • Demonstration Video – Completion and Submission of Application Form
  • Demonstration Video – Amendment to Application Form
  • IIC Leaflet
 pdf Updated
pdfUpdated
pdf video video video vvideo pdf
A3 Application for Proposed Appointment of a Responsible Officer

Apart from Form A3, the proposed responsible officer should also submit Form A1 (together with the supporting documents) if he/she has not applied for a formal licence from IA.  On this note, a deemed licensee is required to submit Form A1 if he/she has yet to apply for a formal licence with the IA.		 pdf
A4 Application for Insurance Broker Company Licence

Please provide the Insurance Authority with the documents specified in the following checklist when submitting the insurance broker company licence application.
  • Checklist of Documents for Insurance Broker Company Licence Application
 pdf pdf
A5 Application for Insurance Agency Licence

Please provide the Insurance Authority with the documents specified in the following checklist when submitting the insurance agency licence application.
  • Checklist of Documents for Insurance Agency Licence Application
 pdf pdf
A6 Application for Approval of the Varying Line(s) of Business by Individual Insurance Agent/TR(A)/TR(B)

Important Notes:
  1. Please submit a Form A6 duly signed by the insurance intermediary (together with the new IIQE result) applying for the IA’s approval of the new line(s) of business under Section 64S of the Insurance Ordinance (“IO”);
  2. To confirm the appointment of the new line(s) of business, the relevant appointing principal(s) should also file a duly completed Form N2 to IA.
  3. Please be reminded to submit Form A6 and an updated Form N2 for the above requests.  Should a letter of the above requests or an outdated form is used, they would be returned to the Applicant/ Appointing Principal accordingly. 
 pdf


Licence Renewal Form

Form Form Details View
R1 Application for Renewal of Licence (Individual Insurance Agent/TR(A)/TR(B))

For individual licence renewal application (individual insurance agent/TR(A)/TR(B)).
Licensees are encouraged to submit licence renewal application via IA’s e-portal, namely, Insurance Intermediaries Connect.

Important Notes:
  • Under Section 64ZV of the IO, renewal application of a licensed insurance intermediary may only be made no later than 45 days before the licence is due to expire.  Otherwise, IA will not be able to guarantee that such application will be processed before the expiry date.
Online Portal - Insurance Intermediaries Connect

Licensed individual insurance agents, licensed technical representatives (agent) and licensed technical representatives (broker) are required to activate an Individual Account of Insurance Intermediaries Connect for e-submission of applications for renewal of licence. For more information about the Insurance Intermediaries Connect, please refer to the following user guides:
  • User Guide of the Insurance Intermediaries Connect for Individuals - Licence Renewal Application
  • User Guide of the Insurance Intermediaries Connect for Principals - Licence Renewal Application
 Please visit IA's Online Portalpdfpdf
New
R4		 Application for Renewal of Licence (Insurance Broker Company)

Important Notes:
  • Under Section 64ZV of the IO, renewal application of a licensed insurance intermediary may only be made no later than 45 days before the licence is due to expire. Otherwise, IA will not be able to guarantee that such application will be processed before the expiry date.
 pdf
New
R5		 Application for Renewal of Licence (Insurance Agency)

Important Notes:
  • Under Section 64ZV of the IO, renewal application of a licensed insurance intermediary may only be made no later than 45 days before the licence is due to expire. Otherwise, IA will not be able to guarantee that such application will be processed before the expiry date.
 pdf


Notification Forms

Form Form Details View
N1 Notification of Termination of Appointment

Under section 64R of the IO, within 14 days after the day on which an authorized insurer, a licensed insurance agency or a licensed insurance broker company (collectively, “Appointing Principal”) terminates the appointment of a licensed insurance agency, a licensed individual insurance agent, a licensed technical representative (agent), a licensed technical representative (broker) or a responsible officer (as the case may be), the Appointing Principal should notify the IA in writing of the termination.		 pdf
N2 Notification of Appointment

Under section 64Q of the IO, at least 14 days before an authorized insurer, a licensed insurance agency, or a licensed insurance broker company (collectively, “Appointing Principal”) appoints a licensed insurance agency, a licensed individual insurance agent, a licensed technical representative (agent), a licensed technical representative (broker) (as the case may be), to carry on regulated activities in one or more lines of business as an agent of the Appointing Principal, the Appointing Principal should notify the IA in writing of the intended appointment.		 pdf
N3 Notification of Change in Particulars (Individual Insurance Agent/TR(A)/TR(B)) 

Important Notes:
  1. Under section 64P of the IO, a licensed insurance intermediary must notify the IA in writing of any change of particulars (i.e. name, business or residential business, telephone number or email address) within 14 days after the date on which the change takes place.
  2. For change of name, please provide a copy of the new identification document (e.g. HKID) and a copy of the deed poll/change of name deed as the supporting documents.
 pdf
N4 Notification of Change in Particulars (Insurance Agency/Insurance Broker Company) 

Important Notes:
  1. Under section 64P of the IO, a licensed insurance intermediary must notify the IA in writing of any change of particulars (i.e. name, business address, telephone number or email address) within 14 days after the date on which the change takes place.
  2. For change of name and business address, please also submit the new business registration certificate and the notification forms filed with the Companies Registry as the supporting documents.
 pdf
New
N5		 Notification of Change in Partners, Directors or Controllers of a Licensed Insurance Agency or Licensed Insurance Broker Company

Important Notes:
  1. Under section 64ZZD of the Insurance Ordinance, a licensed insurance intermediary must notify the IA in writing of any change in partners, directors or controllers within 1 month after the date on which the change takes place.
 pdf
  Forms for notification of other changes in relation to licensed insurance intermediaries required under the IO will be available soon.  Meanwhile, please write a formal letter to the IA stating the relevant particulars for compliance with the relevant requirements.  Please note that the original signed letter is required to be submitted.

 

Supplemental Forms

Form Form Details View
S1 Supplemental Form – Information on Other Licence(s)  pdf
S2 Supplemental Form – Information on Bankruptcy, Liquidation or Similar Proceedings pdf
S3 Supplemental Form – Information on Criminal Record  pdf
S4 Supplemental Form – Information on Disciplinary Action Record  pdf
S5 Supplemental Form – Information on Director/Controller (Individual) pdf
S6 Supplemental Form – Information on Director/Controller (Body Corporate)  pdf
S7 Supplemental Form – Termination of Appointment

Please note that Form N1 – Notification of Termination of Appointment should be completed first. Form S7 is a supplemental form to Form N1.		 pdf

Other Forms

Form Form Details View
-- Continuing Professional Development (CPD) Declaration Form

for the CPD Assessment Period of 2022 - 2023		 pdf
O1 Request for Licence Revocation by Licensed Insurance Intermediary pdf