2026 Appointment/Drop Down Form

2026 Appointment/Drop Down Form

Licensing information to appoint and add non-resident powers.
SGA name*
Full Name:*

First NameLast Name
Agent Number*
FREE NPN LOOKUP
Reason for adding Drop down*
if approval is needed, please attach below.
NPN*
State/Province to add*
If Florida, please complete county designation below
FL Counties
Press CTL to select multiple options
License Number*
Lines of Authority:*

Life onlyA&H onlyLife and Health
E-mail:*
MGA Name*

First NameLast Name
Attach approval(s) as needed

Browse Files
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