Fraternal Insurance Agent License - Initial

Applicable to: Individuals, at least 18 years of age and of good moral character. Description: Application for first-time license/appointment, amendment and reinstatement; fees; license requirements; miscellaneous forms and links. License/appointment to solicit, negotiate or sell Life/Accident & Health insurance or Annuities on behalf of Fraternal Societies. Statute: CGS 38a-764, 800 Transaction Type: Initial Duration: Biennial. License expires December 31 of odd-numbered years.

Prerequisites: Residents - None. A Producer license is not required to apply for this license type. NOTE: Fraternal Societies can't appoint Producers in CT. Insurance Companies can't appoint Fraternal Agents in CT. Required Documentation: Completed application, fee, and any documentation required based on a "yes" answer to a question. Nonresidents must provide evidence of equivalent license in any other state. Other Information: Application must be submitted by a licensed Fraternal Society. Must submit paper application. We are not accepting electronic submissions at this time. Only Fraternal Societies can license/appoint Fraternal Agents. Applications, Forms & Other: Application for Fraternal Agent License/Appointment (Fraternal Societies ONLY) REQUEST FORM (Certification/Clearance Letter) REQUEST FORM (Duplicate License) Appointment Cancellation Form - Fraternal Agents STATUTES - Title 38a - Insurance

Application Fee: Eff Oct 1 2009 - $130 payable to Treasurer, State of CT Fee Exemptions: None

Agency: Department of Insurance Phone: (860) 297-3955 Mailing Address: State of Connecticut Insurance Dept, Licensing Division (Standard Mail: PO Box 816, Hartford, CT 06142-0816) (Overnight Mail: 153 Market St, 7th Fl, Hartford, CT 06103) Email Address: toby.sullivan@ct.gov Website:     www.ct.gov/cid/ Agency Notes: None

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