Get the free Attachment D Producer Appointment Application

Attachment D Producer Appointment Application By completing this Producer Appointment Application, the undersigned is applying to be a non-exclusive Producer to Molina Healthcare, Inc., on behalf

How to fill out attachment d producer appointment

How to Fill Out Attachment D Producer Appointment:

1. Start by entering your name, contact information, and the name of your insurance agency in the designated fields at the top of the form.
2. Fill in the date on which the appointment is being made.
3. Provide your National Producer Number (NPN) and your state insurance license number.
4. Indicate whether you are applying as an individual or as a business entity. If you are applying as a business entity, provide your business name, address, and any other requested information.
5. Specify the lines of authority for which you are seeking appointment. This may include categories such as life insurance, health insurance, property and casualty insurance, or others.
6. If applicable, indicate any appointment termination date, renewal date, or conditional appointment requirements.
7. Provide details about any current or prior disciplinary actions related to insurance licenses you hold.
8. If you are applying for appointment as a surplus lines broker, provide the necessary information and documentation as required by your state's laws and regulations.
9. Review the completed form for accuracy and completeness before submitting it.

Who Needs Attachment D Producer Appointment?

1. Insurance agents and brokers who want to be appointed with insurance carriers or companies may need to fill out Attachment D Producer Appointment. It is a standard form used to authorize an agent to represent an insurance company and offer their products.
2. Independent or captive insurance agents who plan to sell insurance policies on behalf of a specific company or multiple companies may require this appointment form.
3. Business entities, such as insurance agencies or brokerage firms, that want to establish relationships with insurance carriers and be authorized to sell their products may also need to complete Attachment D Producer Appointment.

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What is attachment d producer appointment?

Attachment D producer appointment is a form used by insurance companies to appoint a producer to act on their behalf in selling insurance policies.

Who is required to file attachment d producer appointment?

Insurance companies are required to file attachment D producer appointment when appointing a producer to sell insurance policies on their behalf.

How to fill out attachment d producer appointment?

To fill out attachment D producer appointment, the insurance company must provide information about the appointed producer, including their contact details and the type of insurance they are authorized to sell.

What is the purpose of attachment d producer appointment?

The purpose of attachment D producer appointment is to formally appoint a producer to act on behalf of an insurance company in selling insurance policies.

What information must be reported on attachment d producer appointment?

The attachment D producer appointment form must include information about the appointed producer, such as their name, contact information, license number, and the type of insurance they are authorized to sell.