MOFB Agent Appointment – OCi Services

OCI has been supporting agents with the products, tools, and services to help agents serve their clients and increase their income since 2002.

Completion of this form will set you up with OCI as your general agency partner, as well as set you up on our platform.

PLEASE NOTE: After you are set up with OCI, you will need to get contracted with the carrier(s) that you plan to sell. Completing this form does not get you contracted with a carrier.

Do you have new business to submit? (This includes referrals sent to our split case team.)

Yes
No

You have full access to all of OCI's products and services. We ask you to complete this form only when you are ready to submit business and your client has agreed to move forward with the application. Thank you.

Client Name:*

First Middle Last

Agent Name:*

First Middle Last

Preferred Name

Social Security Number*

Date of Birth:*

Phone*

Business Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

License Information

National Producer Number*

Copy of License(s)*

Drop files here or

Max. file size: 100 MB.

Do you have a copy of your own E&O coverage?*

Yes
No

Copy of E&O*

Max. file size: 100 MB.

Annuities

Will you be writing annuities with OCI?

Yes
No

Please upload your Annuity Suitability Training Certificate.

Max. file size: 100 MB.

Protecting your private information is important to OCI Insurance & Financial Services, Inc (“OCI”) and our employees. We want you to understand what information we collect and how we use it. In order to provide our customers with a broad range of products and services as effectively and conveniently as possible, we use technology to manage and maintain customer information. The following policy serves as a standard for all OCI employees for collection, use, retention, and security of nonpublic personal information.

View OCI Privacy Policy

I certify that I have downloaded and read the above privacy statement.*

I Agree

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Getting Set Up With OCI - MOFB Agent

License Information

Annuities