For Individual applicants only.

List your Insurance Agency Affiliations, if applicable.

Note: Complete only if the applicant is to be listed as an active member of the business entity.

Note: To find your affiliates NPN number, go to NPN Search page. To find their FEIN, you will need to contact the organization directly.

If needed, you may add additional rows by clicking .

Note: If you have no information to enter on this page you can skip it and proceed to the next step.

Click .