4. The representative must also transmit to the Authority, or authorize the Government, its government bodies, a professional order or any other person in Québec to transmit to the Authority on its behalf, the following documents and information:(1) his name and, where applicable, any other name which the representative intends to use in Québec in carrying on his activities, the address of the location which serves as an establishment in Québec, the telephone and facsimile numbers concerned, as well as his mailing address and his electronic-mail address, where applicable;
(2) his residential address;
(3) in the case of a representative intending to register in the sector of damage insurance, the name and residential address of all the persons employed by him and referred to in section 547 of the Act;
(4) as the case may be, a copy of the declaration of registration made in accordance with the Act respecting the legal publicity of enterprises (chapter P-44.1) and any amending declarations thereto;
(5) a copy of the insurance contract purchased by the representative indicating that he is covered by liability insurance in accordance with the requirements of the Regulation respecting firms, independent representatives and independent partnerships (chapter D-9.2, r. 2);
(6) a declaration signed by the representative confirming whether the representative:(a) has ever had a certificate issued by the Conseil des assurances de dommages, the Conseil des assurances de personnes or the Inspector General of Financial Institutions pursuant to the Act respecting market intermediaries (chapter I-15.1) or by the Association des courtiers et agents immobiliers du Québec that has been cancelled or suspended or has ever had a registration cancelled or suspended by the Commission des valeurs mobilières du Québec;
(b) has ever had a certificate for one or more sectors or classes of sectors or his registration cancelled or suspended by the Authority;
(c) has ever had his registration cancelled or suspended by the Authority;
(d) is the holder of a certificate issued by the Authority or a registration with the Authority which has rights that are subject to conditions or restrictions;
(e) is in default of paying any outstanding fines and legal costs imposed on him by the discipline committee of the Chambre de l’assurance de dommages or the Chambre de la sécurité financière or the Court of Québec, sitting in appeal from a decision of such committees, as well as the accrued interest at the rate established in accordance with section 28 of the Tax Administration Act (chapter A-6.002), as the case may be;
(f) is in default of paying any fine pertaining to the commission of an offence pursuant to the Act, the Act respecting market intermediaries, the Securities Act (chapter V-1.1) or the Real Estate Brokerage Act (chapter C-73.2);
(7) a copy of the declaration the content of which is set out in Schedule 3 respecting the opening and maintaining of a separate account and, in the case of an independent representative not intending to receive or collect any amount on behalf of others in connection with his activities governed by the Act, a copy of the declaration the content of which is set out in Schedule 4.