Agent Appointment Forms

Agent Appointment Forms are located here. 

All Agents/Agencies that will receive/retain commissions or are involved in the sales or solicitation of a Limited Benefits/Indemnity group plan must be appointed through the underwriting company (i.e., BCS Insurance Company, Companion Life Insurance Company, etc).

The following information is required:

·         Agent Appointment Information Form for the underwriting company
·         W-9
·         Broker Single Case Agreement
·         A copy of the insurance license is needed for each of the following:
o        The agent/agency to whom commissions are paid.
o        For the agent(s) involved in the sale or solicitation of the insurance.
o        For the state in which the agent/agency is domiciled.
o        For the state in which the group is sitused.