AO: Drop-down Request Form

*To simplify the process for requesting non-resident dropdowns and to expedite the handling of these requests, AIL has adjusted the current procedure. Beginning on Monday, Oct. 23 all Dropdown Requests must be completed using this new process:

Navigate to the new JotForm for Dropdown Requests and save it as a Favorite/Bookmark: https://form.jotform.com/AILicensing/appointmentdrop-down-request-form
Select the SGA name from the dropdown at the top of the form (A-H-H-V or A-H-H-V-Lorence).
Complete and submit the form.
Update eApp daily and if after five days the dropdown is not there, please email altiglic@ailife.com to follow-up on your request.

There is no requirement to submit the Appointment Request on the Agency Resource Center or the previous Dropdown Request JotForm. This new form replaces both of those steps.

If you have any questions, please reach out to chrisvasu@altig.com.

*PLEASE ENSURE YOUR APPOINTMENT REQUEST HAS BEEN SUBMITTED ON ARC WHENEVER APPLICABLE PRIOR TO SUBMITTING THIS REQUEST

PLEASE MAKE SURE ALL INFORMATION IS ACCURATE

First Name*

Last Name*

Agent Number*

Non-Resident License Number*

Non-Resident Province/State*

Request sent in Arc?

MGA*

First NameLast Name

Office Name*

*The state you have selected is considered “out of territory”. In order to complete this request, a recruit must be approved by AIL.

In order for the request to be approved, please ensure the recruit is a personal recruit (it cannot be a candidate who came from a vendor, a resume, or a paid job posting), AND the Recruit Name is not the same as the Recruiter.

Please provide the information below:

Name of Recruit*

First NameLast Name

Name of Recruiter*

First NameLast Name

How does the Recruit know the Recruiter?

*How does the Recruit know the Recruiter?

Lines of Authority*

Override or Writing*

If writing, what counties?*

Resident License State*

Resident License Number*

NPN*

Appointing License State*

Temp or Perm*

License Expiration Date*

What is the immediate purpose of this request?*

Select why you need the request completed.

Please upload a copy of the associated Arc Request to verify the request was submitted

Browse Files

* Files should be clearly labeled with Name, State, and document type

Please upload a copy of the Agent's Non-Resident license to verify Proof of License*

Browse Files

* Files should be clearly labeled with Name, State, and document type

*Please wait 48 hours from the Active Date shown on license to submit this drop-down request and the ARC (when applicable) to ensure the request is completed

Please enter the Requestor's email address below:*

example@example.com

AO Drop-down Requests