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Providing Agents with Specialty Health & Life since 1961.           
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Contact us at National Insurance Markets, Inc. Contact Us
915 Saxonburg Blvd, Suite 217
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 Co

:: Allianz Agent Licensing (3-2010)

American Continental Ins Co

:: ACI Agent Contracting (11-08)


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
:: Assurant/Time Assignment Form


Assurity Life

:: Assurity Agent Licensing

AXA Equitable

:: AXA Agent Contracting

Banner Life

:: Banner Agent Contracting

Capital Blue Cross

:: CBC Agency Contracting
:: CBC Agent Contracting
:: CBC Business Associate Agreement
:: CBC Standard Agent Acknowledgement Form C-155


Cigna

:: Cigna Agent & Agency Contracting

Colonial Life & Accident

:: Colonial Broker Contract Kit

Coventry Health Care

:: Coventry Agent Contracting


Fidelity & Guaranty Life

Agent Licensing document coming soon.

Fidelity Life

:: Fidelity Life Agent Contracting

Fidelity Security Life

:: Fidelity Security Agent Contract

Genworth Life & Annuity

:: Genworth Agent Contracting (2010-06)
:: Genworth Assignment Form


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
:: GTL Agent & GA Commisison Contract


Hartford Life

:: Hartford Agency Contracting
:: Hartford Individual Contracting


HealthAmerica

:: HA Agent Contracting
:: HA W-9 Form


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
:: HHIC PFFS Disclaimer Attestation 2009


Highmark BS Individual & Group Medical

:: HBS Producer Licensing
:: HBS Producer Cert. of Completion
:: Highmark Privacy Security Training Certification Form
:: Licensing Checklist
:: Group Licensing Schedule F (7-2010)
:: HHIC ADDENDUM


Highmark BS Medicare Advantage

:: HBS Central Senior Products Agreement
:: HBS Integrity Training Form
:: HBS Privacy Training Certification Form
:: HM PFFS Disclaimer Attestation 2009


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

Met Life

:: Met Life Contracting
:: Met Life Direct Deposit


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% Med Supp Commission
:: New Era W-9 Form


Petersen International

:: PIU Producer Agreement

Presidential Life

:: Presidential Life Licensing

Prudential

:: Prud. Agency Contracting
:: Prud. Individual Contracting
:: Prud. Direct Deposit


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
:: UHL Sub/Agent Assignment Contract (5-2010)
:: UHL Commission Schedule (5-2010)


United of Omaha

:: UO Contracting

United World

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


UPMC

Submit a copy of your state license and E&O.

West Coast Life

:: WCL Contracting

Western Reserve Life

:: WRL Contracting
:: WRL EFT Form


Western & Southern Life

:: WSL Agent Contracting

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