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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
Fax: (412)782-2868
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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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