New Producer Appointment Application
 
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Please submit Part 1.  Once we review Part 1, you will receive an email from us with further instructions regarding Part 2. The same applies to Part 2.

Upload Files:  You must save this document as a "Draft" and then you will be able to upload the required files.  Please attach the current year to date and prior year end production reports for the agency’s three largest personal lines carriers from the last 3 years.

Agency/Broker Contact List & Producer Business Center/ePCG access : AIG Personal Lines maintains a proprietary internet site for all appointed Producers.  We also have ongoing communication by email whenever possible. Please provide information for ALL personal lines employees in this section (include all Principals, Producers CSRs, etc.)

Definitions*

Parent/Subsidiary Producer Codes: All Broker User ID’s that are set up under a parent broker code can view their book of business as well as all the clients of broker codes established as a subsidiary. All ID’s that are set up under a subsidiary code can only view the clients in the subsidiary’s book of business. 

Agency/Brokerage Information

1. Agency/Brokerage Name and FEIN #*
   % Number
2. Mailing Address*
   % Number
3. Mailing City*
   % Number
4. Mailing State*
   % Number
5. Mailing Zip Code*
   % Number
6. Mailing Country*
   % Number
7. First Name*
   % Number
8. Last Name*
   % Number
9. Phone*
   % Number
10. Email*
   % Number
11. Fax Number
   % Number
12. Physical Address: (If different than Mailing)
   % Number
13. Physical City
   % Number
14. Physical State
   % Number
15. Physical Zip Code
   % Number
16. Type of Business*
17. Describe Organization*
18. What Internet Browser and version does your agency currently use?*
   % Number
19. Company URL
   % Number

License Information

20. Are you currently appointed by AIG commercially?*
21. Have you been terminated by any insurance carrier in the past 5 years?*
22. Have you ever had complaints registered against you with any Department of Insurance, or other state regulatory agency?*
23. Have you ever been fined or disciplined by any licensing authority?*
24. Do you currently have an Excess and Surplus License?*
25. Carrier for your Errors and Omissions Policy?*
    25.1. Limit*
   % Number
    25.2. Deductible*
   % Number
    25.3. Expiration date (MM/DD/YYYY)*
   % Number

Agency/Broker Profile

26. Have you ever been appointed with AIG Personal Lines in the past?*
27. Do you currently utilize a wholesaler or another broker to write personal lines insurance with AIG?*
28. Total Agency Commercial and Personal Lines Premium Volume*
   % Number
    28.1. Personal Lines*
   % Number
    28.2. Commercial*
   % Number
29. Total Personal Lines High Net Worth premium (defined as accounts > $10K or rounded accounts that contain a $1M home replacement cost):*
   % Number
    29.1. Total Personal Lines High Net Worth New Business Year to Date:*
   % Number
    29.2. Total Personal Lines High Net Worth New Business Prior Year End:*
   % Number
    29.3. Total Personal Lines New Business Year to Date:*
   % Number
    29.4. Total Personal Lines New Business Prior Year End:*
   % Number
30. What State(s)/Region(s) do you actively market?*
Available Options Selected Options

 
 

Please segment your total personal lines client base by the following:

31. Total Premium of accounts under $9,999 written premium*
   % Number
    31.1. Total inforce of accounts under $9,999
   % Number
    31.2. Total Premium of accounts $10K-$24,999 written premium
   % Number
    31.3. Total inforce of accounts $10K-$24,999
   % Number
    31.4. Total Premium of accounts $25K-$49,999 written premium
   % Number
    31.5. Total inforce of accounts $25K-$49,999
   % Number
    31.6. Total Premium of accounts over $50,000 written premium
   % Number
    31.7. Total inforce of accounts over $50,000
   % Number
32. Premium volume of homes < $1M*
   % Number
    32.1. Number of homes < $1M
   % Number
    32.2. Premium volume of homes $1M - $3M
   % Number
    32.3. Number of homes $1M - $3M
   % Number
    32.4. Premium volume of homes $3M - $5M
   % Number
    32.5. Number of homes $3M - $5M
   % Number
    32.6. Premium volume of homes > $5M
   % Number
    32.7. Number of homes > $5M
   % Number

As of Prior Year-End, provide the following information on your top 5 insurance carriers

33. Select Carrier 1*
34. Select Carrier 2
35. Select Carrier 3
36. Select Carrier 4
37. Select Carrier 5

As of Prior Year-End, provide the following information on your top 5 high net worth personal lines carriers

38. Select Carrier 1*
39. Select Carrier 2*
40. Select Carrier 3*
41. Select Carrier 4*
42. Select Carrier 5*
43. Have you consolidated any markets in the last 5 years?*
44. Are you looking to sell your agency or acquire other agencies over the next 12-24 months?
   % Number
45. Why are you looking for another personal lines high net worth market?
   % Number
46. Do you conduct annual business planning within your agency and with all your carriers?
47. Do you meet carrier commitments?

What percentage of your business is written from the following sources?

48. Customer Referrals*
   % Number
49. Commercial Cross-Sell*
   % Number
50. Digital Marketing/Direct Mail*
   % Number
51. Centers of Influence*
   % Number
52. Social Media*
   % Number

Personal Lines Staff

53. Total # of personal lines staff*
   % Number
    53.1. # with HNW expertise*
   % Number
    53.2. # of Personal Lines Producers*
   % Number
    53.3. PL Manager*
   % Number

Please Confirm Required Documents have been Uploaded - Save as draft before uploading

54. Yes I uploaded my carrier production reports*
55. Yes I uploaded my E&O declaration page*

Submitter Information

56. Signed By*
   % Number
57. Signed Date*
   % Number
58. I certify that the information I provided in this online application is accurate and complete based upon my knowledge and belief at the time it was entered.*
 
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