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Thank You for your request to be Contracted with one of our carriers.

The completion of our Contracting Questionnaire is a One-Time activity on your part.

  1. CONTRACTING QUESTIONNAIRE
  2. BROKER PROFILE
  3. Annuity FAQ
  4. Contracting FAQ
  5. Importance of Certain Pre Appointment requirements

These are generic forms that will be used for all our LIFE, LONG TERM CARE, DISABILITY INCOME AND ANNUITY Insurance Carriers. In the future, as you contract with new carriers, this stored information is used to complete contracting paperwork on your behalf, increasing speed and efficiency.

In order to set you up in our Contracting System you must complete our Contracting Questionnaire and Fax to 518-688-8139 Attn-Rich along with copies of your Licenses, E&O* Coverage Certificate and copies of your AML and Long Term Care CE Certificates of Training.

By signing the signature page, you are attesting the information you are submitting is true and accurate and you authorize us to submit your information through the contracting system to selected carriers.

*Remember if you are covered under your Corporation's / Agency's E&O Policy... we will require a letter from your Corporation, Agency or E&O Carrier on their letter-head stating you are covered under their E&O policy...along with a copy of the E&O Coverage Certificate.

PLEASE REMEMBER:
  • We require copies of your Insurance License’s, E&O Coverage Certificate, LTC CE Certificates, AML Certificate.
  • The Contracting Form is a FILLABLE PDF Just open and type.
  • We Hold Contracting forms until we know that you are writing a new case by providing our office with:
    • Clients Name
    • Clients Residence State
    • State where application signed
    • Insurance Company
    • Product Sold
    • Date of Application

Affiliation and Licensing and Contracting Information for
New York / National Long Term Care Brokers
and it's Affiliated Companies.

Affiliation: After we received your request to be affiliated with NLTCB--NYLTCB, we will send you our Affiliation Forms for completion. When you return your affiliation forms, you may request contracting forms for any of our life, long-term care, DI or annuity carriers

Required Documents: Once we have your Affiliation Forms, and our Contracting Questionnaire and copies of all necessary licenses, CE certifications (LTC and AML), and E&O coverage certification, we will process all of your contracting requests once you have or will be writing a new business policy.

Effective Date of Appointments: Many states have "Just-in-Time" appointments, which means that the carrier will appoint you with the receipt of a new business application. There are a few states that re- quire you to be appointed prior to soliciting an application, and we will advise you of a state's "pre-appointment" rules at the time of your request to be contracted with a particular carrier.

Errors & Omissions (E&O): Most carriers require you to carry E&O coverage, and we will require a copy of your E&O coverage certificate that shows your name. If you are covered under a blanket policy with your agency or corporation, then a letter from your E&O carrier stating that you are covered can be accepted.

Long-Term Care Partnership (LTCI) CE Certification is required for most states. Check with

"ClearCert," an approved education vendor, at their Web Site www.clearcert.com Click on "regulations" to discern if your state has any special solicitation requirements as well as which education vendors offer the required training.

Contract Date: Technically, your appointment date on all of your contracting forms must be before any signature dates on new business. You will be notified via email or mail when your appointment has been completed.

Appointment Fees are required by some carriers if you are requesting additional appointments in non- resident states. We will advise you of non-resident appointment fee requirements.

AML Training: Anti-money laundering training is required for all life, annuity, and DI carrier appointments. Log on to the course at https://aml.limra.com.

REMEMBER to contact our Licensing & Contracting Coordinator, Rich Altier, at ext. 129 or RAltier@NYLTCB.com before you take an application with any carrier. Rich's fax number is 518-688-8139.