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915 Saxonburg Blvd, Suite 217
Pittsburgh, PA 15223

Telephone: (412)782-1979
Toll Free: (800)235-2013
Fax: (412)782-2868
eMail: info@nimbroker.com
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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 (1-2009)
American Continental Ins Co
:: ACI Agent Contracting (11-08)
American Progressive/UAFC
:: UAFC Agent Contracting
American Sentinel
:: American Sentinel Agent Contracting
:: W-9 Form
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 Life
:: Fidelity Life Agent Contracting
Fidelity Security Life
:: Fidelity Security Agent Contract
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
:: GTL Agent & GA Commisison Contract
Hartford Life
:: Hartford Agency Contracting
:: Hartford Individual Contracting
HealthAmerica
:: HA Application For Agent Appointment
:: HA ONE Certificate Of Completion
:: HA Producer Agreement & Addendum
:: HA Producer Commission Amendment A
:: 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 Medical
:: HBS Producer Licensing
:: HBS Producer Cert. of Completion
:: Highmark Privacy Security Training Certification Form
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
:: IAC Indiv. Producer Agreement
:: IAC Indiv. Commission Addendum
:: IAC Direct Deposit Form
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
National States
:: Agent Contract Form (pdf)
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
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
Important Insurance Links
» PA Department of Insurance
» NIPR License Registry
» Sircon
» HIPAA/HITECH Information
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