Get New Agent Enrollment Form

The New Agent Enrollment Form is an essential document for onboarding new agents. This guide will help you navigate the process of completing the form online, ensuring you provide all required information accurately.

Follow the steps to fill out the form effectively

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling in your agency name and number. Ensure these match your official documents to avoid any discrepancies.
3. Provide your business address, including city, county, state, and zip code. Make sure this information is current for correspondence purposes.
4. Enter the agency email address, phone number, and fax number to facilitate communication.
5. Indicate your agency’s website to help potential clients reach you online.
6. Record the year your agency was formed, total staff, and the count of sales staff. This data helps in assessing your agency's experience.
7. Provide your federal tax identification number and attach a copy of your 1099 form as required.
8. Answer whether your business is incorporated by selecting 'Yes' or 'No.'
9. Confirm if you have Errors and Omissions (E&O) coverage of $1 million or more.
10. Indicate if you possess resident and non-resident licenses, and if so, list the systems used.
11. State whether you utilize an agency management system and provide its name if applicable.
12. Attach your written business plan and provide your last year-end financial report as part of the application.
13. Complete the section about principals and commercial lines staff, ensuring all names and emails are correct.
14. Fill in how your producers are compensated—select from salary, commission, combined, or other.
15. Provide details regarding your agency's writings, including specific lines of business and associated premiums.
16. Detail your agency's market segments, specifying which segments you write for.
17. List any major commercial accounts, including premium sizes, and any major market players operating in your office.
18. If applicable, describe any special agreements with other markets that pertain to your agency.
19. Rank what's important to you on a scale of 1 to 10 for factors such as coverage, commissions, and ease of doing business.
20. Indicate if you have any existing business with Chubb through a Managing General Agent (MGA) and provide relevant details.
21. Finally, provide any additional comments that may assist in your application.
22. Ensure all sections are complete and accurate before proceeding to save your changes, download, print, or share the completed form.

Complete the New Agent Enrollment Form online today to ensure timely processing of your enrollment.