Aetna Notice of Intent Form

Notice of Intent to Transfer Option

There is a 90-day waiting period from the date you submit your onboarding case to when the change is processed. You may continue to write business during the waiting period.
1. Requesting For*

Agent OnlyAgent and Downline
2. Name of your new upline*
3. Individual agent or agency requesting this move:
Agent name*
Agency name
Signature*

Clear
Date*

MonthDayYear
Date
National Producer Number or TIN*
Select the "Preview PDF" button below to view and download a copy of your completed form.
Note: If you do not wish to digitally complete the form, you may download a copy of the form here and complete the "Notice of Intent to Transfer Option": https://workdrive.zohoexternal.com/external/ea7d04186888aca3760cef6e1ac71008f7b13767297806f0a84068a92ad6a7ae
Should be Empty: