New Agent Profile
Please complete all sections to provide your onboarding information as a new agent. All information will be reviewed for compliance and contracting.
Personal Information
First Name
*
Last Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Primary Address
*
City
*
State
*
Zip Code
*
County
*
Mailing Address
City
State
Zip Code
NPN Number
*
Resident state license
*
Linkedin profile link
Social Media profiles (business).
Years of Experience
*
Website link
Non Resident Producer Licensed States
Types of Insurance Sold
Current or anticipated networking groups/activities
Errors and Omissions Carrier
Errors and Omissions Policy Number
Coverage Limits
Policy Expiration Date
-
Month
-
Day
Year
Date
Copy of Errors and Ommission certificate
Upload a File
Drag and drop files here
Choose a file
Drag and drop or browse to upload supporting documents related to Errors and Omissions.
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Licenses & Certifications
Health
Yes
Life
Yes
AHIP
Yes
LTC/STC Partnership
Yes
AML certification
Yes
Do you sell under 65 health insurance?
Yes
Other relevant certifications
Upload supporting documents or certifications
Upload Document
Drag and drop files here
Choose a file
Upload one supporting document if needed.
Cancel
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Ramsey Solutions - Endorsed by Dave Ramsey
We are elite advisors endorsed by Dave Ramsey and have ethical and procedural requirements above and beyond general ethics required by licensing. Do you know who Dave Ramsey is? Do you understand his principles of wealth protection? Please describe what you know and if you are willing to learn his principles.
Carriers Contracted
Manhattan Life
Yes
No
Aetna Senior & Ancillary
Yes
No
One America
Yes
No
Mutual of Omaha
Yes
No
Thrivent
Yes
No
National Guardian Life
Yes
No
United Health
Yes
No
Devoted
Yes
No
Humana
Yes
No
HealthSpring (cigna)
Yes
No
Aetna Medicare
Yes
No
Ameritas
Yes
No
Physician Mutual
Yes
No
GTL
Yes
No
Nationwide
Yes
No
United American
Yes
No
Allstate
Yes
No
Other
Background
Any prior disciplinary actions, complaints, or regulatory issues (please explain and upload supporting documentation)
Prior experience/companies
What value will you bring to Laura Peery Agency?
What time commitment can you make? Are you looking for an hourly LOA position or are you working commissions? Are you interested in growing your business and learning new lines of business such as long-term care? Have you sold long-term care?
What is your understanding of the need for long-term care planning as an overall retirement planning element?
Book a Call to review your goals and our requirements.
Signature
Date
Submit Onboarding
Submit Onboarding
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