• NFI Solutions, Inc.
    350 W Burnsville Parkway, STE 360, Burnsville Parkway, Burnsville, MN 55337
    O: 952-887-1239 | Fax: 952-657-7568 | Contracting@NFIsolutions.com www.NFIsolutions.com

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  • Dear Valued Agent,

    Thank you for taking the time to complete the following information! If you ever have any questions, please do not hesitate to contact us.

    To complete your licensing request, please complete the following licensing questionnaire. The questionnaire information will be submitted through our online licensing system, SureLC, which is a program that allows us to save your information in our system. Please be aware that some carriers require the agent to verify the completed paperwork that is generated through our SureLC system. In the event that you receive an email notification from SureLC, please review and acknowledge the completed paperwork. In the future, should you desire to be appointed with any additional carriers, NFI Solutions will already have your information saved on file, allowing us to submit and complete your appointment in a timely manner.

    Please allow 24 hrs. for contracting paperwork that is in good order to be submitted to the carrier for review. Licensing requests that are submitted in good order are in most cases approved by the carrier within 7 business days.

    The following documents must be submitted to NFI Solutions in their entirety:

    • Agent Personal Information Licensing Questionnaire
    • Copy of E&O certificate
    • Letter of explanation for “yes” responses
    • Proof of AML completion
    • Certificate of Signature Authorization
    • State annuity suitability training
    • EFT form and copy of voided check
    • Jurisdictional & Venue Agreement

    Before taking an application, please remember to complete your NAIC state specific annuity suitability training and any required carrier product specific training. The instructions for completing the training can be found on our website, NFIsolutions.com

    If the above requirements are not met within 30 days of the request, your appointment request will be closed until paperwork is received in good order.

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  • AGENT HIERARCHY TRANSMITTAL

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  • 350 W Burnsville Parkway STE 360| Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

  • Agent Information

  • Date of Birth*
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Move In Date
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  • Residential (No PO Boxes) Move In Date
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  • AML Completion Date
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  • Instead of uploading a certificate, feel free to click HERE to verify your AML training in SureLC! You can remove access to training providers anytime within your SureLC account.

    • STEP 1 — Log in to SureLC through the provided link above.
    • STEP 2 — Click on the “Training” Tab.
      Once logged in, click the Training tab in the top navigation.
    • STEP 3 — Add Your Training ProvidersIn the Training Concierge section, sign in to your applicable providers (e.g., LIMRA, QuestCE, AHIP, WebCE, Kaplan, etc.)
    • STEP 4 — Confirm Monitored Accounts
      After connecting, your linked providers will appear under Monitored Accounts.


    What Happens Next

    • SureLC automatically syncs completed training records and NFI receives updates instantly.
    • You get reminders before renewals are due
    • Training and Licenses automatically populate in NFI's SureLC - no more manual uploads!
  • Are you a registered rep with FINRA?
  • Doing Business As....
  • Complete the following only if DBA a Business Entity:

  • Format: (000) 000-0000.
  • 350 W Burnsville Parkway, STE 360 | Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

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  • AGENT INFORMATION - Employment History

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  • Address History: Please provide the past 5 years. Please attach additional information if necessary.

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  • 350 W Burnsville Parkway, STE 360| Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

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  • ELECTRONIC FUND TRANSFERS (EFT)

  • Format: (000) 000-0000.
  • Account Type
  • Date Signed*
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  • 350 W Burnsville Parkway, STE 360 | Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

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  • Consent to Electronic Delivery of Forms 1099-NEC – Nonemployee Compensation

    Publication 1179 of the Internal Revenue Service requires a Payer to receive affirmative consent from recipients to deliver Forms 1099-NEC electronically. This correspondence will provide you with disclosures required under IRS requirements. If after reading the disclosures below you choose to have your 1099-NEC delivered electronically, please return this consent form.
  • IMPORTANT DISCLOSURE INFORMATION

  • 1) If you do not consent to electronic delivery, you will receive a paper 1099-NEC in the mail, which will be delivered to the address that we currently have on file.

    2) Your consent to electronic delivery will apply to all future 1099-NECs unless consent is withdrawn by you (see point 4 below)

    3) If for any reason you would like a paper copy of your 1099-NEC after you have consented to electronic delivery, you may submit a request via e-mail (see #10 below) or send a written request to (see #11 below) Requesting a paper copy of your 1099-NEC will not be treated as a withdrawal of consent.

    4) If you would like to withdraw your consent to electronic delivery, you may submit a notice via e-mail (see #10 below) or send a written request to (see #11 below) Your consent is considered withdrawn on the date the Payer receives your written request to withdraw consent. The Payer will confirm the withdrawal and its effective date in writing. A withdrawal of consent does not apply to a 1099-NEC that was e-mailed to you in accordance with IRS Requirements before the effective date of the withdrawal of consent.

    5) The Payer will cease providing Forms 1099-NEC to you electronically if you provide a notice to withdraw consent, if you are no longer a Recipient or if regulations change to prohibit the form of delivery.

    6) If you need to update your contact information that we have on file, e-mail the update to (see #10 below).

    7) We will notify you if there are any changes to the contact information of the Payer.

    8) You will need a computer, printer and Adobe Acrobat software to access, print and retain your 1099-NEC.

    9) Your 1099-NEC may be required to be printed and attached to a federal, state or local income tax return.

  • Consent to Electronic Delivery?
  • Date
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  • 350 W Burnsville Parkway, STE 360 | Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

  • Request for Taxpayer Identification Number and Certification

  • Check appropriate box for federal tax classification. If Limited Liability Company, please include tax classification in the "Other" Box.
  • Taxpayer Identification Number (TIN)

  • Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

    Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter

  • Certification

    Under penalties of perjury, I certify that:
  • 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


    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.


    Certification instructions. You must cross out item 2 above 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. For real estate transactions, item 2 does not apply. For mortgage interest paid,
    acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
    other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

  • Date*
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  • General Instructions

    Section references are to the Internal Revenue Code unless otherwise noted.
  • Future developments
    For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

    What’s New
    Line 3a has been modified to clarify how a disregarded entity completes
    this line. An LLC that is a disregarded entity should check the
    appropriate box for the tax classification of its owner. Otherwise, it
    should check the “LLC” box and enter its appropriate tax classification

    New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

     

    Purpose of Form
    An individual or entity (Form W-9 requester) who is required to file an
    information return with the IRS is giving you this form because they must obtain your correct taxpayer identification number (TIN), which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable
    on an information return. Examples of information returns include, but
    are not limited to, the following.

    • Form 1099-INT (interest earned or paid).
    • Form 1099-DIV (dividends, including those from stocks or mutual
    funds).
    • Form 1099-MISC (various types of income, prizes, awards, or gross
    proceeds).
    • Form 1099-NEC (nonemployee compensation).
    • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers).
    • Form 1099-S (proceeds from real estate transactions).
    • Form 1099-K (merchant card and third-party network transactions).
    • Form 1098 (home mortgage interest), 1098-E (student loan interest),
    and 1098-T (tuition).
    • Form 1099-C (canceled debt).
    • Form 1099-A (acquisition or abandonment of secured property). Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.


    Caution: If you don’t return Form W-9 to the requester with a TIN, you
    might be subject to backup withholding. See What is backup withholding, later.

    By signing the filled-out form, you:
    1. Certify that the TIN you are giving is correct (or you are waiting for a
    number to be issued);
    2. Certify that you are not subject to backup withholding; or
    3. Claim exemption from backup withholding if you are a U.S. exempt
    payee; and
    4. Certify to your non-foreign status for purposes of withholding under
    chapter 3 or 4 of the Code (if applicable); and
    5. Certify that FATCA code(s) entered on this form (if any) indicating
    that you are exempt from the FATCA reporting is correct. See What Is
    FATCA Reporting, later, for further information. Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.


    Definition of a U.S. person For federal tax purposes, you are considered a U.S. person if you are:
    • An individual who is a U.S. citizen or U.S. resident alien;
    • A partnership, corporation, company, or association created or
    organized in the United States or under the laws of the United States;
    • An estate (other than a foreign estate); or
    • A domestic trust (as defined in Regulations section 301.7701-7). Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 1441–1474). Under those rules, if a Form W-9 or other certification of non-foreign status has not been received, a withholding agent, transferee, or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient, owner, transferor, or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.
    The following persons must provide Form W-9 to the payor for purposes of establishing its non-foreign status.

    • In the case of a disregarded entity with a U.S. owner, the U.S. owner
    of the disregarded entity and not the disregarded entity.
    • In the case of a grantor trust with a U.S. grantor or other U.S. owner,
    generally, the U.S. grantor or other U.S. owner of the grantor trust and
    not the grantor trust.
    • In the case of a U.S. trust (other than a grantor trust), the U.S. trust
    and not the beneficiaries of the trust. See Pub. 515 for more information on providing a Form W-9 or a certification of non-foreign status to avoid withholding.

     

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  • 350 W Burnsville Parkway, STE 360| Burnsville, MN 55337

    O:952-887-1239 | F: 952-657-7568 | contracting@nfisolutions.com

  • JURISDICTIONAL and VENUE AGREEMENT

    (Choice of Law - Minnesota)
  • This Jurisdictional Agreement shall be applicable to every insurance company and/or agent with whom the undersigned is contracted and wherein NFI Solutions is the undersigned's upline.

    Should NFI Solutions have to enforce the terms and conditions of any Annualization Agreement and/or become responsible for collecting any debit balance of the undersigned for any reason whatsoever, the undersigned agrees that for purposes of said enforcement and/or collection jurisdiction shall be vested in and be governed by the laws of the State of Minnesota. Should enforcement and/or collection proceedings become necessary, venue of said proceedings shall be lodged in the County of Dakota, Minnesota or elsewhere as specified by NFI Solutions.


    Should enforcement proceedings become necessary, NFI Solutions shall be entitled to recover attorneys' fees, court costs, collection fees/costs and costs of suit. If it becomes necessary to refer this matter to a collection agency, a minimum cost of 35% will be added to the principal owed to NFI Solutions. The parties agree this Jurisdiction and Venue Agreement shall be governed by the laws of the State of Minnesota and this Agreement shall not be complete until accepted by NFI Solutions in Burnsville, Minnesota. This Agreement shall be deemed executed in Burnsville, Minnesota, County of Dakota. By signing below I acknowledge that I have read the foregoing and agree to be bound by the terms and conditions set forth herein.

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