I, , hereby apply for MBI certification.

I certify to MBABC and MBIBC each of the following as being true:

• I have successfully completed the MBI qualification course concerning ethics and professional conduct.
• I have passed continuing education courses required for registration renewal through MBIBC.
• I am a member in good standing of MBABC and acknowledge I will be subject to its code of ethics and conduct as
  amended from time to time.
• I am a registrant under the Mortgage Brokers Act of British Columbia.

I understand the certification is valid as long as I:

• continue to pass continuing education courses required for registration renewal through MBIBC;
• continue to be a member in good standing of MBABC;
• continue to be a registrant under the Mortgage Brokers Act of British Columbia;
• follow the codes of ethic and conduct of MBABC (including any similar codes), including any future amendments;
• abide by any future rules and regulations of the MBI certification developed by the education committee, MBI standards committee, or other committee authorized by MBIBC; and
• have not been sent a notice of revocation by MBIBC.

Upon the certification becoming invalid I agree to immediately cease using the designation (including but not limited to ceasing to display the MBI Diploma Certificate and ceasing to use designation letters MBI) and, if requested, return the Diploma Certificate to MBIBC. I understand it is contrary to law for me to use the MBI certification or Certification Diploma without MBABC having authorized me to do so and authorizing me to continue to do so.

All fields are mandatory.

Signature: Date:

Full legal name - First: Middle:

Last:

Company name I am registered under, in full:

Email address:

Phone Number:

Mailing address:

1. I will pick up the Certification Diploma at the following MBABC event:
   
   
2. I will pick up the Certification Diploma at the MBABC office:
   
   
3. Priority mail or courier the Certification Diploma, at my cost, to the address indicated above. You can use Visa or MasterCard by calling MBABC at 604-408-9989 or email accounting@mbabc.ca. For a single shipping charge, we can send Certification Diplomas for up to 3 recipients to a single address).