gov.ns.ca - Nova Scotia Canada - Government of Nova Scotia

Insurance Forms

Consumer / Industry

  • NS Garage Automobile Policy Form 4 - 2016 (pdf)
  • NS Automobile Standard Policy Form 1 - 2016 (pdf)
  • Insurance Enquiry and Complaint Form  (pdf)
  • NS Automobile Standard Policy Form 1 - 2013 (pdf)
  • NS Automobile Standard Policy Form 1 - 2005 (pdf)
  • NS Garage Automobile Policy Form 4 - 2013 (pdf)
  • Direct Compensation - Property Damage Undertaking (pdf)
  • Life Insurance Replacement Declaration (pdf)
  • Nova Scotia Accident Benefits Initial Claims Process (pdf)
  • Notice of Loss and Proof of Claim Form NS-1 (pdf)
  • Claim for Disability Benefits NS-1a (pdf)
  • Treatment Plan NS-2 (pdf)
  • Confirmation of Services Provided NS-2a (pdf)
  • Progress Report NS-3 (pdf)
  • Concluding Report NS-4 (pdf)
  • Referral Form NS-5 (pdf)
  • DCPD List of Insurers (pdf)
  • DCPD Undertaking form (pdf)

    AGENTS

    Notice to New Insurance/Adjuster License Applicants - September 2015

    Individual Insurance Licence Application (pdf)

    • Use when applying for new license, or making changes to an existing license (e.g. sponsor transfer). To renew without changes, please use form sent by mail. More information: Agent Licensing and Application FAQs.
    • Registration to write exam for: LLQP full Life, LLQP Accident & Sickness, General Insurance Level 1
      Insurance Exam Registration Form (pdf)

    AGENCIES

    Corporate Insurance Licence Application (pdf)

    • Use when applying for new license, or making changes to an existing license (e.g. sponsor transfer). To renew without changes, please use form sent by mail. More information: Agency Licensing and Application FAQs

    General Insurance Agencies

    ADJUSTERS

    Individual Adjusters - Individual Insurance Licence Application (pdf)

    • Use when applying for new license, or making changes to an existing license (e.g. change in employer). To renew without changes, please use form sent by mail. More information: Adjuster Licensing and Application FAQs

    Partnership or Corporate Adjuster - Corporate Insurance Licence Application (pdf)

    INSURANCE COMPANIES (Insurers)

    Canadian Council of Insurance Regulators Application for Insurer’s Licence (pdf)

    INSURANCE PREMIUM TAX FORMS (Insurers)

    • First Quarter General Premium (pdf) (doc)
    • First Quarter Life Premium (pdf) (doc)
    • Second Quarter General Premium (pdf) (doc)
    • Second Quarter Life Premium (pdf) (doc)
    • Third Quarter General Premium (pdf) (doc)
    • Third Quarter Life Premium (pdf) (doc)
    • Annual Life Premium Tax Form (pdf) (doc)
    • Annual General Premium Tax Form (pdf) (doc)

    Annual Fire Prevention Tax Form (pdf) (doc)



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    Tel: 902-424-5613
    Fax: 902-424-1298
    Email: novascotia.ca



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