Get Securian Life Insurance Company F80586 2021-2025

Filling out the Securian Life Insurance Company F80586 form is a crucial step for brokers seeking appointment in various insurance lines. This guide provides a clear, step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the Securian Life Insurance Company F80586 correctly.

1. Click the ‘Get Form’ button to retrieve the Securian Life Insurance Company F80586 form and open it for editing.
2. Indicate the lines of business you are requesting appointment for by checking the appropriate boxes: Life, Annuity, or Employer plan (401K). Ensure that your entity has the necessary selling agreement with Minnesota Life or Securian Life.
3. Provide your broker information by entering your full legal name as it appears on your insurance license. Fill in the fields for first name, middle name, last name, and suffix.
4. Enter your date of birth in the format mm/dd/yyyy and your Social Security number for identification purposes.
5. Provide your email address for confidential communication, along with your residential and business addresses, including state, city, and zip code.
6. List your preferred telephone number and fax number, making sure these are current for ease of communication.
7. Answer the question regarding selling long-term care products by selecting 'Yes' or 'No.' If 'Yes,' specify the states where you are authorized to sell these products, and include copies of your training certificates.
8. Complete the section regarding Errors and Omissions Insurance by listing the carrier name, effective and expiration dates, and the company's contact person.
9. Respond to the questions regarding your association with a broker-dealer, providing your CRD Number if applicable. You must indicate whether your broker-dealer supervises INDEXED LIFE product sales.
10. Carefully read and respond to the broker declaration section, providing full details if you answer 'Yes' to any question. This may include aspects of bankruptcy, judgments, or regulatory actions.
11. Sign and date the form at the designated area, confirming the accuracy of your provided information. For applicants from Maine or New York, additional information on consumer reports will be provided if requested.
12. After completing all sections, you can either save the changes, download, print, or share the form as needed.

Complete your Securian Life Insurance Company F80586 online now to ensure your appointment process is seamless.