Broker and Agency Appointment

Agency Appointment

This is a two-step process:

1. Add an agency, by filling out the form below.
2. Add broker(s) to the agency, by filling out the subsequent page(s).

In order to become appointed with EMI Health please complete the form below. You will need to submit the following during this process:

• Electronic copy of your current agency Errors and Omissions Certificate.
• Electronic copy of a current, completed and signed agency W-9 (PDF Form)