Licensing

For a new broker/firm or individual:

To become licensed with Assurant Employee Benefits we will need the following completed and mailed to us:

1. Group Producer Agreement and Contract Application Form
   New York | All Other States

2. Fair Credit Reporting Act Consent Form
   All States

3. Current copy of the Life and Health/Disability License for the state in which you are requesting the appointment

For a new writing agent with a firm that is already contracted/appointed with us:

To become licensed with Assurant Employee Benefits we will need the following completed and mailed to us:

1. Group Producer Agreement and Contract Application For Individual Form
   New York | All Other States

2. Fair Credit Reporting Act Consent Form
   All States

3. Current copy of the Life and Health/Disability License for the state in which you are requesting the appointment

Our forms are available in Portable Document Format (PDF). To view the forms, you may need to download the latest version of Adobe^® Acrobat^® Reader which is available free at www.adobe.com.