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An applicaiton packet is to be completed by an insurer's representative for each MGA it utilizes.
An application packet must be received by this Department within thirty (30) days after entering into a contract with the MGA
Follow instructions below to register as a Managing General Agent (MGA)
The application must be tabbed to correspond with its number in this Schedule of Requirements.
Tab 1. Completed MGA application, Application Fee of $100
Tab 2. Certified copy of the Fidelity Bond. (pursuant to IC 27-1-33-6)
Tab 3. Copy of the Errors and Ommissions policy. (pursuant to IC 27-1-33-6)
Tab 4. Copy of the executed contract between the MGA and the insurer. The contract must be highlighted indicating the location of the Indiana code citations that coorespond with the completed Contract Compliance Checklist showing the section and page number of the citations. (pursuant to IC 27-1-33-7)
Tab 5. Proof of licensure as an Indiana agent. (pursuant to IC 27-1-33-6)
Tab 6. Biographical affidavits for each officer, director, or partner of the applicant, originally signed and notarized. And a list of all current officers, directors or partners of the applicant.
Tab 7. Annual financial compilation prepared by an independent certifed accountant. (pursuant to 760 IAC 1-52-6)
*Note* The insurer must correct the omissions or deficiencies in the registration form within thirty (30) days of the date of the latest notice of the department of insurance of such ommissions or deficiencies. If the insurer fails to do so, the registration form file will be closed as an incomplete registration. The registration fee is not refundable.
*Note - All materials must be received by postal mail, faxed or emailed items are accepted*
Submit all items to:
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
Upon approval, a license will be mailed to the MGA.