Important: For your security, you have 23 minutes to complete each step of the application process. If there is a period of more than
23 minutes of inactivity throughout any step of the process, the process will terminate and you will need to restart from the beginning. Each
step is completed when you click the Continue button.
To complete and submit this application, you will be required to provide the following information:
- Licensing Information
- Annual commissions and fees
- Total revenue information
- Names of companies you place business with
- Errors and Omissions coverage history for the past three years
- Errors and Omissions claims history
- Sub-agent information for those requesting coverage (if applicable)
Note: If you are requesting coverage for more than 10 sub-agents/non-employee producers, please contact
a customer service representative at 1-800-247-3448.
Newly Licensed Agents: If you are a newly licensed agent, please complete the entire application, estimating your production and carriers for the
upcoming year.
You will be given the opportunity to review your answers before submitting the application. After you submit the application, a copy of your completed application
will be available to print and retain for your records.
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