National Insurance Markets, Inc

www.NIMBroker.com

Providing Agents with Specialty Health & Life since 1961.

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1-800-235-2013
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	:: Licensing Forms


	:: Applications & Product Forms


	:: Training & Certification


	:: Individual Products

	:: Individual Major Medical

	:: Ancillary Health Products

	:: Short Term Health Insurance

	:: Individual Dental

	:: Individual Disability

	:: Student Health Insurance

	:: Senior Medical

	:: 2010 Medicare Part D

	:: Long Term Care/Nursing

	:: Special Risk Health

	:: Travel Insurance


	:: Group Products


	:: Life Insurance


	:: Errors & Omissions

	Contact Us
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
: : Click Here to Send Us an eMail : : Staff List : : Directions

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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