Humana MGA Assigment Form
AGENT TO GENERAL AGENCY ASSIGNMENT FORM
General Agency Information
GA NAME: Senior Market Advisors
GA NUMBER: 1567
I understand that by signing the attached form I am agreeing to be aligned under the downstream agent hierarchy of the above mentioned General Agency (GA). I may not have to align all segments of Humana business under the designated GA and it is my responsibility to determine which lines of business are affiliated with the above GA.
Please note this is not a Delegated Commission Assignment Form and does not affect commissions.