TSS New Agent-Agency Paperwork

TSS New Agent-Agency Paperwork
Which representative are you working with?*
If you selected "Other", please enter your representative's name here:
AGENT INFORMATION

Please fill out the following fields w/ the individual agent information.
Agent/Principal Name*

PrefixFirst NameMiddle NameLast NameSuffix
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Address (if different than home)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

BusinessHomeOther (please add the address in notes section)
Preferred Phone Number*
Please enter a valid phone number.
Please Select one for Preferred Phone Number*
Alternate Phone Number
Please enter a valid phone number.
Please Select one for Alternate Phone Number
Fax Number
Please enter a valid phone number.
Primary Email*
example@example.com
Alternate Email
example@example.com
Date of Birth*

MonthDayYear
Date
Social Security Number *
National Producer Number (NPN)*
Please enter your active insurance licenses below, starting with your resident license. If you have more than 3 states, please add them to the notes section.*
AGENCY INFORMATION (If Applicable)

Please fill out the following fields w/ the Entity Information if contracting as an Agency.
Agency Name (as it appears on insurance license(s)
Agency Tax ID
Agency NPN
Please enter your active insurance licenses below, starting with your resident license. If you have more than 3 states, please add them to the notes section.
The forms below (ACH and W-9) are fillable. Please complete them and then download and save it to your computer. Next, you will upload a copy in the upload field below. If you do not follow these instructions, we will not receive the completed forms.
Please upload all required items here: Insurance License(s), E&O Certificate, & Voided Check.*

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Please enter E&O details below. If you do not have E&O Coverage, please visit https://form.jotform.com/230235525783052 and fill out the form to be added to our complimentary, group E&O policy. Once the form is submitted, you will receive an email with instructions on how to receive your certificate of coverage.*
Notes: Please enter any additional information that you think we may need. This information will be used to create your agent profile and we can then begin the contracting process.
We will not send you spam. We will never share, sell, or rent your information to anyone, ever. Your information is only used to contact you. By checking the "Yes" box, and entering your mobile phone number in the fields below, you are giving Trusted Senior Specialists permission to contact you via SMS messaging, about marketing opportunities, carrier updates, upcoming trainings, contracting reminders, status changes, and anything else related to doing business with Trusted Senior Specialists. Reply STOP to opt-out, HELP for help, Message & Data Rates may apply.
Mobile Phone Number
I give my permission to Trusted Senior Specialists to contact me via SMS messaging.*

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Code of Ethics

This Code of Ethics was developed to ensure that Trusted Senior Specialists agents soliciting applications for any insurance product have a clear understanding of their moral and ethical responsibilities during every interaction with customers. No statement of policy can be so comprehensive that it covers all possible situations. For this reason, Agents must exercise professional judgment with respect to each work situation that arises, and seek advice from upline management when uncertainty or difficult questions remain.

Agents are expected to comply with both the written and spirit of this Code of Ethics. Violations of this Code of Ethics may be grounds for disciplinary action, including immediate dismissal and termination of the Agent's rights to solicit applications on behalf of Trusted Senior Specialists.

Principles: An Agent shall....

Approach every interaction with integrity

To have integrit is to be fair, objective, and straightforward in all interactions. You are open, honest, and truthful; there are no hidden motives or secret agendas.

Put Customers First

A customers-first philosophy is a guiding principle that should influence every decision you make. This philosophy may lead you to suggest that a customer takes a few days to review materials before arriving at a decision.

Be an expert and stay informed

You are knowledgable about every product you sell and how different products meet different needs. You explain the benefits of products in plain language and appropriate detail so that customers completely understand each product. You display a continuous commitment to lifelong learning and professional improvement.

Sales Practice Guidelines

Prohibited Marketing and Selling Behaviors
1. Activities which are discriminatroy in nature or intended to discourage beneficiary enrollment on the basis of race, physical or mental ability, ethnicity, gender, sexual orientation, creed, age, religion, or national origin, cultural educational background, economic or health status, English proficiency, reading skills, or source of payment for care.
2. Activities that mislead or confuse beneficiaries or which misrepresents Trusted Senior Specialists. Such activities may include, but are not limited to:
  1. Claims of endorsement of the Company you are presenting by CMS or the United States Government.
  2. Claims that CMS recommends the Product you are presenting.
  3. Erroneous written or verbal statements, including statements, cliams, or promises that conflict with or materially alter information contained in CMS approved materials.
  4. Offers of gifts or payments directly or indirectly to beneficiaries or any individual in a position to influence enrollment as an inducement to enroll in the plan being presented.
  5. Door-to-door solicitation.
  6. Altering or amending, in any fashion, any Company approved materials.
  7. Engaging in health screening of prospective members or in activites which could reasonably be construed to be health screening.
  8. Submitting fraudulent enrollment forms, or forging any enrollment form or supporting documentation.
  9. Distributing materials or soliciting enrollment at any healthcare delivery site while care is being delivered.
  10. Soliciting any endorsements or patient lists from any health providers.
  11. Selling leads.
  12. Soliciting any enrollment from beneficiaries; incompetent to complete and understand the Statement of Understanding from the enrollment form. Individual clearly incompetent shall only be enrolled when accompanied by appropriate representation.
  13. Engaging in any "bait and switch" activities or other fraudulent behaviors, including, but not limited to, overselling, churning, and "sliding" unnecessary additional policies.
  14. Engaging in agressive selling techniques or ignoring customer needs.
3. Agents will understand a customer's unique needs and only sell a product if it fits their needs.
4. Agent will make a "best effort" to ensure that all customers fully understand their options and the features of the products they purchase.
I am committed to maintaining Trusted Senior Specialists reputation as a quality and reputable insurance agency. I clearly understand the above statements and accept this Code of Ethics as my standard for conducting business while representing Trusted Senior Specialists.
By electronically signing, you acknowledge that all information provided is true and complete, and that you understand and agree to the Code of Ethics.*

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TSS New Agent-Agency Paperwork

AGENT INFORMATION

AGENCY INFORMATION (If Applicable)