TSLIC AGENT SIGN UP

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1. You will be required to upload a form of identification (Texas Driver’s License, Texas Identification Card, U.S. Passport).

Note: If you do not have one of the acceptable forms of identification, please wait until you have them before proceeding with this Sign-Up process.

2. Complete all required sections (marked with red *).

3. Review your information to make sure it is complete and accurate.

4. Complete the electronic Signature Process and select the SEND DOCUMENTS button to transmit them to the Agent Services Department.

5. You will be able to Save and Continue Later by pressing the icon at the bottom of the form. If you choose to use this option, you will need to complete and submit the form within 24 hours.

6. The Agent Services Department (agentservices@tslic.com or 800-756-7306) will check your documents and contact you by email and/or text.

Let's Get Started!
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The following questions will help to expedite the filling out of your Agent Application.

You will have an opportunity to review the information prior to submitting the application to TSLIC.
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Name* This field is required.
First, Middle Name
Last Name
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Date of Birth* This field is required.
Date
Month
Day
Year
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Referring Sales Director Name (If Known)* This field is required.Please select a Sales Director if known, or select the region you are in.
Please Select
Please Select
North and East Texas
Shellie Hollis - South Central Texas
Armando Dominguez – South East Texas
Ruben Ontiveros – West Texas & Rio Grande Valley
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General Agent/ Recruiting Agent Name
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In order to be appointed with TSLIC you will need to provide either a Social Security Number or an FEIN number.* This field is required.If filing as a business entity your business must be licensed by the Texas Department of Insurance. If filing with an Individual Taxpayer Identification number (ITIN) you will need to submit work authorization forms if needed.
Social Security Number
FEIN
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Social Security Number* This field is required.
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FEIN* This field is required.
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Mailing Address* This field is required.
Street Address
Apt./Suite Number
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Form of Identification* This field is required.You Will Be Required to Upload a Copy of Your ID
Texas Driver's License
Texas Identification Card
United States Passport
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Email Address* This field is required.
example@example.com
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Mobile Number* This field is required.
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Alternate Phone Number
Please enter a valid phone number.
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Select a Text Message Option* This field is required.
I AGREE to receive periodic text messages. Message & Data rates may apply. You can ask us to stop any time. Our Privacy Policy can be found at www.tslic.com/privacy-policy.
I DECLINE to receive text messages.
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Preferred Language
English
Spanish
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How did you hear about Texas Service Life Insurance Company?
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Have you ever worked as an Agent for another Insurance Company?* This field is required.
Yes
No
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List other Insurance Companies where you have worked as an Agent:
Company Name
From-To-Dates
Type of Insurance Sold
Most Recent
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Previous
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Most Recent
Previous
Company Name
Row 0, Column 0
From-To-Dates
Row 0, Column 1
Type of Insurance Sold
Row 0, Column 2
Company Name
Row 1, Column 0
From-To-Dates
Row 1, Column 1
Type of Insurance Sold
Row 1, Column 2
1 of 2
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Do You have an existing/active Life Insurance Agent License?* This field is required.
Yes
No
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Texas Department of Insurance License Type* This field is required.Check appropriate boxes
Life, Accident & Health
Life (only) Agent
Life Not Exceeding $25K
Preneed
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Type a question
Type option 1
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Type a question
Type option 1
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License Number:* This field is required.
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In the PREVIOUS CALENDAR YEAR did you sell life insurance policies in Texas that totaled LESS THAN $20,000 IN PREMIUM PAYMENTS for the entire year?* This field is required.If you need to obtain a Texas Insurance Agent's License, TSLIC can provide the TRAINING and TESTING required to be licensed.
Yes - I wrote less than $20,000
No - I wrote more than $20,000
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Agent Affidavit Regarding Balances (you MUST check one of these boxes.)* This field is required.
I have never owed any insurance company any monies or agent's balances.
I have repaid any outstanding Agent balances owed to any insurance company(ies) and do not currently owe monies to any insurance company arising out of my representation of the insurance company or its products or services
I currently owe outstanding Agent balances to insurance company(s)
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Please describe:
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Have you ever had an insurance license revoked or suspended?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
Yes
No
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Have you ever been charged or convicted of a crime?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
Yes
No
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Have you done business/held a license under another name?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
Yes
No
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Have you ever been involuntarily terminated or permitted to resign from an Insurance Company position, including acting as a sales agent for the company?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
Yes
No
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Have you or any business in which you are or were an owner, partner, member, officer or director EVER filed bankruptcy?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
Yes
No
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Are you subject to any terms or conditions, Non-Piracy, or Non-Compete agreements with any other person or company?* This field is required.AGENT WARRANTS THAT THE FOLLOWING RESPONSE APPLIES TO AGENT AND IS TRUE AND CORRECT
None
Yes
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Please Explain:
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Once appointed with TSLIC, you can choose to have your Commissions paid on a daily or weekly basis. Please select one.* This field is required.The Company has the absolute right, at its sole discretion, to switch your daily commission payments to a weekly basis.
Daily (Requires Direct Deposit)
Weekly
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Would you like to sign up for direct deposit?* This field is required.Note: This authority is to remain in full force and effect until the Company has received written notification from agent of its termination in such time and in such manner as to afford a reasonable opportunity to act on it.
Yes
No
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Account Type* This field is required.
Checking
Savings
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Depository Bank Name* This field is required.
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Depository Bank Location Information* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Routing Number* This field is required.
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Account Number* This field is required.
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Please Re-enter Your Account Number* This field is required.Account numbers much match exactly or you will be prompted to re-enter your account number.
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account number map* This field is required.
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In the event of your death, who would you like to receive any remaining commission payments?* This field is required.
Named Person (CANNOT BE SELF)
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Do you have a business name for tax reporting purposes?* This field is required.
Yes
No
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Business Name/Disregarded Entity Name
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Check the appropriate box for federal tax classification. ONLY ONE of the boxes may be marked.* This field is required.
Individual/Sole Proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/Estate
Limited Liability Company
Other
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Enter the Tax Classification* This field is required.
C
S
P
C= C Corporation, S= S Corporation, P= Partnership
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Under penalties of perjury, I certify that:* This field is required.1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and You must cross out item 2 if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
I have read the above statement
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You're Almost Done!

It’s time to upload the required documents and apply your signature.

1. Next you will be prompted to upload a scanned copy or photo of your identification.

2. You will review the application and apply your signature(s) to the document via Adobe Sign.

3. If you are required to sign the Agent Affidavit regarding policy values sold, you will be redirected to that form after you click "Submit." The Agent Affidavit form will auto-populate your personal information but you will be required to re-enter your email address and sign the form electronically.
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Please Upload a Copy or Photo of Your ID* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Applying & Affixing Signatures
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Agent Initials* This field is required.Use your mouse, finger, or stylus to enter your initials
Clear
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Sign Document* This field is required.Enter your email address to start the Adobe Sign process. This process will allow you to review the entire paperwork before applying your signature. Once "Signing Complete" appears, please press "Next."
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Date Signed* This field is required.
Date
Month
Day
Year
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What Happens Next?

Please print a copy for your records. Press "Preview PDF" at the bottom of this card and then press the “Print” Button. Once you have printed the document click "Back to Form".

If you are not a licensed agent, and you meet the requirements, after you click “Submit” below you will be directed fill out an affidavit.

This affidavit will allow you to start selling our preneed products while you obtain a license. The form will auto-populate your personal information but you will be required to re-enter your email address and sign the form electronically.

Once we have processed and approved your application, you will receive a Welcome Letter with your TSLIC agent number, as well as instructions for logging in to our agent website for training materials, forms, etc.

Copies of your executed Agent Agreement and Commission Schedules will be emailed to you upon your request.

Upon receipt of your “First” new business application, please allow (7) days for commissions to be paid.

If you have any questions about this paperwork, please call us at 800-756-7306 and ask for Agent Services or email agentservices@tslic.com and we will be happy to answer any questions you might have.

Click "SUBMIT” below to complete the application process.

P.O. BOX 341899, AUSTIN, TEXAS 78734 PH (800) 756-7306 FAX (512) 263-7714 EMAIL: AGENTSERVICES@TSLIC.COM
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