Candidate Questionaire

New Agent Questionnaire

Phone: (800) 551-0080

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Name: *

Address:

City:

County you reside in:

State

Zip:

Resident License:

Yes No

Phone: ( Cell / Home / Work)*

Email: *

How long have you been Health Insurance Licensed? *

How long have you been Life Insurance licensed? *

Do you currently have E/O insurance?

Yes No

If yes, date it expires

Are you AHIP certified?

Are you AML certified?

What carriers are you currently appointed with?

“When did you last write business?”

Is there anything in your past that would prevent you from getting appointed with UIG carriers?

How many applications did you write last year? Your best month?

How are you generating leads currently and how much do you spend per month?

How many appointments are you setting on average each week?

I have sold products before.

I am newly licensed and have not sold any products.

Not Licensed

- Medicare Advantage

- Medicare Supplement

- Life/Final Expense

- Annuities

- LTCI

- Ancillary health

- Other:

Total 100%

Is there anything that would prevent you from going to work immediately and running 15 or more appointments a week if you were given the opportunity?

What are your income expectations in the next 12 months?