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Contact us at National Insurance Markets, Inc. Contact Us
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Pittsburgh, PA 15223

Telephone: (412)782-1979
Toll Free: (800)235-2013
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Licensing Documents & Forms

 If you have any questions regarding the licensing documents below, please contact us at 1-800-235-2013 or info@nimbroker.com

AARP (UHC)

 :: AARP Agent Contracting

Allianz Life Insurance Company

 :: Allianz Agent Licensing (3-2010)

American Continental Insurance Company

 :: ACI Agent & General Agent Contract
:: ACI Agent Contracting
:: ACI Final Expense Contract Addendum

American National Insurance Company

 :: American National Agent Contracting (7-2007)

American Progressive/UAFC

 :: UAFC Agent Contracting

American Sentinel

 :: American Sentinel Agent Contracting
:: W-9 Form

American United Life/One America

 :: AUL Agent Appointment Form - Individual (2-2002)

Assurant Health/Time Insurance

 :: Assurant/Time Agent Appointment Form
:: Assurant/Time Agent Compensation Worksheet
:: Assurant/Time Agent Contract (1-2011)
:: Assurant/Time Assignment Form

Assurity Life

 :: Assurity Agent Licensing (6-2011)
:: Assurity Solicitor’s Assigning Contract (6-2011)

AXA Equitable

 :: AXA Agent Contracting

Bravo/HealthSpring
:: HealthSpring/Bravo Agent Contract Packet


Banner Life

 :: Banner Agent Contracting

Cigna

 :: Cigna Agent & Agency Contracting

Colonial Life & Accident

 :: Colonial Life Broker Contracting Kit

Coventry Health Care

 Beginning September 1, 2010, Coventry will not accept paper contracts; paper contracts will be rejected. Contracting for Senior products available through agent portal.

Fidelity Life

 :: Fidelity Life Agent Contracting

Fidelity Security Life

 :: Fidelity Security Agent Contract

Forethought Life Insurance Company

 :: FLIC Agent Contracting

Genworth Life & Annuity

 :: Genworth Agent Contracting

Gerber Life

 :: Gerber Agent Contracting
:: Gerber 16.5% Level 1 Comm.

Great American (Loyal American&United Teachers)

 :: GAFRI Licensing (Word Document)   OR
:: GAFRI Licensing (pdf)

Guaranteed Trust Life (GTL)

 :: GTL Agent Appointment Contract

Hartford Life

 :: Hartford Agency Contracting
:: Hartford Individual Contracting

HealthAmerica

 :: HA Agent Contracting

Highmark BCBS Individual & Group Medical

 :: HBCBS Producer Licensing
:: HBCBS Integrity Training Form
:: Highmark Privacy Security Training Certification Form
:: Highmark Product Training Cert. Form
:: HHIC Group Appointment

Highmark BCBS Medicare Advantage

 :: HBCBS Senior Products Licensing Addendum
:: HBCBS MA Integrity Training Form
:: Highmark Part D Producer Certification (doc)

Highmark BS Individual & Group Medical

 :: HBS Producer Individual Products licensing (5-2010)
:: Highmark Privacy & Security Training Certification Form
:: Group Licensing Schedule F (7-2010)

Highmark BS Medicare Advantage

 :: HBS Central Senior Products Agreement
:: HBS Integrity Training Form
:: Highmark Part D Producer Certification (doc)

Humana

 :: Humana Agent Licensing (2-2010)
:: Delegated Amendment
:: Consumer Authorization

ING Annuity & Life

 :: ING Agent Contracting

IBN/AMLI (Insurance Brokers Network)

 :: AMLI Appointment Package

Insurers Admin Corp. (IAC)

 :: IAC Agent Licensing Packet

International Medical Group (IMG)

 :: IMG Producer Agreement

John Hancock

 :: John Hancock Contracting

Lincoln Benefit Life

 :: LBL Agent Licensing

Lincoln National Life

 :: LNL Agent Contracting

Medico

 :: Medico Agent Contracting Checklist
:: Medico Agent Personal History Form
:: Medico Solicitor Personal History Form (Assigning)
:: Medico Agent Distribution Agreement
:: Medico Business Associate Agreement
:: Medico Replacement Acknowledgement Form
:: Medico Agent Direct Deposit Form
:: visit: http://www.gomedico.com/

Met Life

 :: Met Life Contracting

Monumental Life

 :: Monumental Life Contracting

Mutual of Omaha

 :: MOO GA & Agent Contracting
:: Special Agent Assigning Contract

New Era Life

 :: New Era Agent Contract
:: New Era Application for Appointment
:: New Era 15% Commission Level (06-2011)
:: New Era W-9 Form

Petersen International

 :: PIU Producer Agreement

Presidential Life

 :: Presidential Life Licensing

Prudential

 :: Prud. Agent Contracting

Reliance Standard

 :: RSLI Agent Licensing

TransAmerica Life

 :: TA Contracting

United Concordia

 :: UCCI Producer Agreement
:: UCCI Producer Information Form
:: UCCI W-9 Form

United HealthCare (Group)

 :: UHC Group Agent/Agency Licensing Agreement

United Home Life

 :: UHL Contracting

United of Omaha

 :: UO Contracting

United World

 :: UW GA & Agent Direct Contract
:: Special Agent Assigning Contract

UPMC

 :: UPMC Agent Licensing (Individual)
:: UPMC Agent Licensing (Group)

West Coast Life

 :: WCL Contracting

Western Reserve Life

 :: WRL Contracting

Western & Southern Life

 :: WSL Agent Contracting

The Medicare Frontier
Today’s Fastest Growing Market

:: Senior Product Home
:: Senior Product Materials
:: Applications & Forms
:: Training & Certification
:: Licensing Forms
:: Request a Plan Comparison


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