AMIG instructions: Please forward the completed form back in my direction (along with any individual state licenses). After which I can send on to our clerical department and AMIG for processing on their end. Let me know of any questions.
AMIG Tips: The pdf is a form fill document. Hand-written forms are not accepted. Please do not print or scan.
Nature of Request: “Please use drop down on form”.
For Individuals leave the tax ID and Agency email blank as they won’t pre-fill anyway. For the Agency/Agency Principal this needs to be completed.
A social security number is required.
Be sure to mark the States in which you are licensed and desire to quote business.
Those States should coincide with current non-resident authority on file with PIU.
The User Name for single sign on is left blank.
Assigned Agency code is: 222001
The sub-producer code is: leave blank
Save the pdf per the instructions on the form and email to me.
AEGIS instructions: Aegis Portal User Request FormYou requested an affiliation with Aegis as an option for Mfg. Home business. The process for securing login credentials, download and EFT set up are found within the link below.
You will need: All user NPN’s, OR and/or WA license copies to attach, Voided checks for Trust and Operating accounts.
Producer code will be 75-xxxx – Insert last 4 digit in the upper right-hand corner on the Setup Sheet before submitting.
The individual submitting the Setup Sheet for the agency and all users will be notified of all logins and will receive email communications on the initial setup, typically within 48 hours.
If page 1 is filled with Licensed Individual Users, please continue listing them on page 2.
