Steps to Getting Appointed With
Allied National Carriers

Please read and/or print these instructions before using the forms. The Allied National   appointment system is simple! Simply fill-out your appointment forms, print, and then mail, fax or e-mail completed forms.

To complete your appointment, please follow these steps:

1. From the list of links below, select a form and click on the link to the pdf.
   
2. When you have completed all of the required information, review for accuracy.
3. Print finished form and sign on the signature line.
4. Return completed form to one of the following:
   1. E-mail:  underwriting@alliednational.com
   2. Fax:  (913) 945-4397
   3. Mail:  Licensing
                Allied National
                P.O. Box 29187
                Shawnee Mission, KS 66201-9187

Please Note: If this is your first carrier appointment with Allied, you must fill out the Allied commission agreement and W9 forms to authorize commission payment. You must also submit photocopies of your current state license by e-mail, fax or mail to the addresses above.

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Carrier Appointment and Compensation Forms

Health Products

• Allied Agent of Record Appointment Form - This form is required for Healthcare Highways (HCH) cases.
  
  
• Companion Life Appointment Form
• Standard Life and Accident Insurance Company Appointment Form 
• Fidelity Security Life Insurance Company Appointment Form - Fidelity Security Life uses an online appointment process. Please contact Allied sales for details when you wish to become appointed​.

Compensation Forms

• IRS W9 (required for first carrier appointment) - Required for first carrier appointment.
  

• Allied Compensation Agreement (required for first carrier appointment) - Required for first carrier appointment.
  
• Agent Schedule of Compensation
  
• Direct Deposit Authorization Form

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Resources

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