Complete an insurance special broker’s monthly return

Special brokers must submit a monthly return for any month they do business with an insurer licensed outside Yukon.

Submitting this form is a requirement under the Yukon's Insurance Act and a condition of your licensing.

How to submit

1. Download and complete the form.

• Do not leave a section blank.
• You may enter “not applicable” when it’s relevant.
• We may return incomplete submissions.

2. Sign the oath section in front of a notary public. Then, have the notary sign and witness your signature.

3. Submit your form.

• In person or by courier at 307 Black Street, Whitehorse, Y1A 2N1. We're open Monday through Friday from 8:30 am to 4:30 pm.
• Email: insurance.plra@yukon.ca
• Fax: 867-667-3609
• Mail:
  Government of Yukon
  Professional Licensing and Regulatory Affairs (C-5)
  Box 2703
  Whitehorse, Yukon Y1A 2C6

We typically process forms within 10 business days. If we have any questions regarding the content of your submission, we'll contact you.

Remember you must also pay outstanding insurance premium taxes on the policy written.

Learn how to submit your insurance premium tax return.