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The Questions Below are Specific to Assurity Life
Please answer each questions and then click the 'Submit' button. Your answers will be electronically forwarded to a contracting team member, who will fill in your contracts for you and fax you any necessary signature pages
It's that easy!
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Have you lived in a different state or county than your present one within the last 5 years? |
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Have you ever been conviced for any offense or pleaded guilty to any misdemeanor or felony charges or have charges currently pending against you or a business with which you are connected? |
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Do you currently have a pending bankruptcy or have you ever filed for bankruptcy, been declared bankrupt or insolvent, or had our salary garnished? |
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Are you at the present involved in any litigation or are there any unsatiisfied judgements or liens (including state or federal tax liens) against you? |
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Have you ever had a bond denied, paid out or revoked?
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Are you indebted to any Insurance Company/Agency/Manager (including debit balance)? |
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Have you ever had any complaints against your conduct that resulted in a return of premium to any insured? |
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Have you ever been fined, suspended, placed on probation, reprimanded, entered into a consent order by any insurance department, the SEC, or any other regulatory authority? |
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Have you ever had an insurance and/or securities license refused/suspended/revoked or currently restricted or under investigation by any insurance department, the SEC, or any other regulatory authority? |
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How many years have you been licensed as an insurance agent? |
Yrs |
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How many companies are you currently contracted with? |
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Contracting Questions - Call
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