Get Mga Application. - State Of Indiana - In

The Managing General Agent (MGA) Application is essential for establishing a registered MGA in the state of Indiana. This guide provides clear and step-by-step instructions to help users complete the application accurately and efficiently online.

Follow the steps to successfully fill out the MGA Application.

1. Click 'Get Form' button to retrieve the application form and access it in your editing tool.
2. Indicate whether this is an Initial Application or a Renewal Application by checking the corresponding box at the top of the form.
3. Ensure that the completed application is submitted within thirty (30) days after entering a contract with the MGA, as it will not be accepted via email or fax.
4. Submit the following documents along with the application: 1. Application fee of $100 for renewal; 2. Original copy of Fidelity Bond renewal; 3. Original copy of MGA's Errors and Omissions renewal policy; 4. Managing General Agent contract and Contract Compliance Checklist; 5. Proof of licensure as an agent; 6. A list of current officers and directors; 7. Biographical affidavits for each newly elected officer, director, or partner, signed and notarized; 8. Independent financial examination; 9. Certificate of Gross Direct Written Premium.
5. Fill in the full name of the insurer, the statutory home address, mailing address, and the contact person’s title and telephone number.
6. Provide information for the MGA, including the name, Federal Identification Number, agent name, agent license number, and contact details.
7. Specify the type of MGA by checking the appropriate box (individual, partnership, corporation, or other) and the lines of insurance that are authorized to transact.
8. Complete the section detailing the duties to be performed on behalf of the insurer, and make sure to include any additional information required.
9. Sign the application confirming the accuracy of the information supplied, along with your title and the date signed.
10. Arrange for a notary public to witness the document, sign it, and include their information along with the expiration date of their commission.
11. Once the form is completed, save any changes, and ensure all accompanying documents are ready for submission via postal mail.

Begin filling out your MGA Application online today to ensure compliance and timely submission.