Forms

WARNING – NY BUSINESS ONLY

REG 187 INDUSTRY AND CARRIER PRODUCT TRAINING MUST BE COMPLETED PRIOR TO NY APP SOLICITATION. CARRIERS WILL RETURN APPLICATIONS NOT IN GOOD ORDER AND NEWLY SIGNED FORMS WILL BE REQUIRED AFTER TRAINING IS DONE.

FOR MORE INFORMATION OR TO COMPLETE PRODUCT TRAINING – PLEASE CLICK HERE FOR MORE DETAILS.

PLEASE BE SURE YOU ALSO COMPLETE THE CARRIER SPECIFIC REG 187 FORM – IF YOU DONT SEE THE FORM WHEN ACCESSING & CHOOSING YOUR APPLICATION FORMS, PLEASE CONTACT OUR OFFICE FOR ASSISTANCE AND THE FORMS WILL BE SENT TO YOU IMMEDIATELY! (NY applications only)

Carrier Applications

Application forms, questionnaires and policy service forms found here!

New York Disclosure Forms

(Required for all NY application submissions only)

Electronic Submission Options

Drop Ticket

and

Full E-APP submission portal

Informal Inquiry

Available on e-Signature

HIPAA Authorization

Available on e-Signature

e-Signature

e-Signature Instruction Guide

e-Signature available with: Informal Inquiry, HIPAA, REG194

John Hancock, Principal and Protective

Innovative Underwriters, LLC works with a variety of insurance carriers. Any product guarantees expressed in a carrier’s policy/contract are backed by the claims paying ability of the issuing carrier and/or its named subsidiary. Innovative Underwriters is a licensed insurance agency in AL, AZ, AR, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. Products may not be available in all states and product features may vary by state. Products may be subject to underwriting. Coverages, benefits, exclusions, and rates depend upon the policy that is issued. This Internet site may provide links to other sites for your convenience in locating related information and services. Innovative Underwriters does not maintain these other sites and have no control over the organizations that maintain the sites or the information, products or services these organizations provide. Innovative Underwriters cannot make any representation or warranty as to the accuracy, timeliness, suitability, completeness, or relevance of any information prepared by any unaffiliated third party, whether linked to this Internet site or incorporated herein, and take no responsibility therefore. Innovative Underwriters does not recommend or endorse these organizations or their products or services in any way. Neither Innovative Underwriters, nor its, agents or employees give tax or legal advice. You or your client should consult with your tax or legal advisor regarding your individual situation. This Website Is Intended For Agent/Broker Use Only And Not For Use With The General Public.

Follow us on

California

Innovative of Pennsylvania Insurance Agency

Nevada

Innovative Insurance, Inc.

New York

Innovative Underwriters Brokerage

Utah

Innovative Insurance Underwriters

California license number – 0E02083

Designed by Apis Productions