Carriers and state insurance departments ask these on every contracting and licensing application. A Yes is not automatically disqualifying; an inaccurate answer usually is.

Have you ever been convicted of, or pleaded guilty or no contest to, any felony, or any misdemeanor involving dishonesty, fraud, or breach of trust? *

Yes

No

Has any state insurance department or other regulator ever denied, suspended, revoked, or placed on probation a license you held, or fined you? *

Yes

No

Has any insurance carrier, agency, or FMO ever terminated your contract or appointment for cause? *

Yes

No

Have you filed for bankruptcy in the last 10 years, or do you have unpaid tax liens or civil judgments? *

Yes

No

Are you currently the subject of any investigation, complaint, or pending legal action related to insurance or financial services? *

Yes

No

Are you currently contracted or appointed with another agency or FMO for Medicare, ACA, or ancillary products? *

Yes

No

If you answered Yes to any question above, please explain

Guardian Benefits — Agent Licensing & Contracting Information