GETTING APPOINTED FORM

GETTING APPOINTED FORM

IMPORTANT. PLEASE READ COMPLETELY. This form will notify some of our preferred carriers that you need to be appointed through Voluntary Insurance Partners, LLC so you can receive commissions from each carrier. This will notify them to reach out to you at your email address to complete every carrier's and vendor's paperwork. In this paperwork you will be completing one single W-9 that will go to each carrier/vendor. You will be selecting the state you are residing in and selecting your upline as well so your requests go to the correct people at each carrier/vendor. - You will also be uploading your E&O Insurance Declaration Page in this form. After this form is complete, you will redirected to additional carrier forms. Do NOT complete this form unless you have your E&O Declaration page, a Voided Check for Direct Deposits, Once this form is completed, your Executive Partners will be notified and they will begin to build your master applications, statement of health forms, and your Official PARTNER APP!

NOTICE: THIS IS NOT YOUR OFFICIAL APPOINTMENT DOCUMENTATION, but a place to communicate with all of our primary carriers at once.

After completing this form, each carrier and vendor will reach out to you for their individual paperwork/appointment completion. Each carrier is different in their processes.

1. Proof of your E&O insurance
2Your Direct Deposit Information

Failure to provide all necessary documentation will result in not being appointed with our carriers.

Today's Date*

MonthDayYear
Date
Name as shown on tax return*

First NameLast Name
Best Contact Phone Number*
2 Business name for your W-9 - if different from above
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes*

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/EstateLimited Liability Company
Limited liability company - Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)*
Enter your Taxpayer intification Number Below - The TIN must match the name given to avoid IRS backup witholding. For individuals, this is generally your Social Security Number. For a business entity this could be your EIN.
Social Security Number: first three - middle two - last four

or EIN for business entity first two - last seven
Signature*

Clear

What Role will you be playing with VIP?*

PARTNER - All tools and Support will be given to me & VIP is paying for my technology, marketing costs, materials, contests and awards.AFFILIATE - Piggybacking off of VIP's Technology, and UnderwritingBROKER - I will lean on my VIP rep to handle my VB offerings for me. I will be letting the VB professionals handle it for me.Other

- If you are a PARTNER with VIP, type in your VOLUNTARYPARTNERS.COM email address in the field below. (first initial, last name,@voluntarypartners.com) - ie John Smith would be jsmith@voluntarypartners.com
- If you are an Afilliate who has vast experience with VB, please use your professional business email address. -
IMPORTANT - WE WILL NOT WORK WITH AN - "@AFLAC.US.COM" email address. This carrier claims ownership of your accounts, clients and more and uses tracking software on what you do with your business when using this email address. Please use a different email address than an Aflac address.
- If you are a Broker Partner, please use your agency email address. The carriers will reach out to you at the email address you provide.
EMAIL ADDRESS*
jsmith@voluntarypartners.com
Choose your MANAGING PARTNER or SR MANAGING PARTNER at Voluntary Insurance Partners*
Choose your Managing Partner. If you don't have a Managing Partner, choose your Executive Partner.
Choose your EXECUTIVE PARTNER at Voluntary Insurance Partners*
Choose your Managing Partner. If you don't have a Managing Partner, choose your Executive Partner.

Commission Structuring
Do you want Advanced Commissions with Assurity or As-Earned? - Advanced pays 50% of the first year commissions upon issuance, and the remaining 50% in months 7 through 12 as invoices are paid.*

I will take Advanced Commissions PleaseAs Earned works for me.

Section 2 - UPLOAD YOUR E&O Declaration Page HERE:
E&O Proof:

PDF, JPG, or PNG Files will work.
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Section 3 - UPLOAD A VOIDED CHECK HERE:

If you do not have a voided check, just have your routing and account numbers ready for each carrier.
VOIDED CHECK FOR DIRECT DEPOSITS:

PDF, JPG, or PNG Files will work.
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You Will be contaced by the following Carriers at your email address provided.
- BEAM/DENTAL VISION (Group)
- 5Star Life Insurance (Group)
- RECURO HEALTH - Telehealth and EAP and VIRTUAL PRIMARY CARE
- ASSURITY - VOLUNTARY WORKSITE BENEFITS
- SEDERA HealthShare
- HEARTLAND PAYROLL SERVICES - Payroll referral
- HUMAN INTEREST - 401K Services
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Because you completed this form, you are sending them a notification that they are to send you contracting paperwork all at once, providing necessary documents, and saving a to of time!
PLEASE DO NOT CLOSE YOUR BROWSER!

YOU WILL REDIRECTED TO FILL OUT YOUR ASSURITY ADVANCED COMMISSIONS AUTHORIZATION FORM AFTER SUBMITTING THIS FORM

ONCE YOU CLICK SUBMIT YOU WILL BE AUTOMATICALLY TAKEN TO THE REQUIRED FORM
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