Register as a DAS broker

To sell DAS legal expense insurance products, please provide the information requested below.

We will then contact you within one business day with more information about our policies and how we support you.

If your brokerage already has a DAS broker code, then sign up for an individual account here.

Register now:
Brokerage Name
Brokerage Address
Principal Name
Principal email address
Principal phone number
Brokerage registration number
You must be contracted with one or more standard insurers. Please identify your lead insurer
Have you been the subject of any disciplinary action from any Provincial licensing body?
If Yes, give details
As a DAS broker, you commit to having your licensed staff complete in-person and/or webinar product training about legal expense insurance.
How did you hear about us?
We require the following information to pay your commission electronically
Name of your Financial Institution (the "Processing Institution")
Postal Code
Transit Number What is this?
Bank Number What is this?
Account Number What is this?
Commission Statement Email
DAS Broker Agreement
Privacy Statement
I confirm I am the Principal Broker and am authorized to sign the above Broker Agreement.
Please enter today's date (DD/MM/YYYY).
The submission of this form by clicking on the [Send] button constitutes your electronic signature indicating your acceptance of the terms and conditions in the Broker Agreement. By signing and sending this form you represent and warrant that (i) the information you have provided is accurate, and (ii) that you have the authority to bind the brokerage described herein to the terms and conditions in the Broker Agreement.
The submission of this form shall be considered your offer to act as a DAS broker. DAS may, at its sole discretion, accept this offer, which acceptance shall be indicated by providing you with a broker code and password information.

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