Your Onboarding starts here

Onboarding Packet

Pre Requirements 

To complete this form, make sure you have these items readily available

  • Personal information Including Social Security Number, Date of Birth, Current Address

  • Designation of Commissions: As Earned (Month to Month) or Advanced

  • Proof of current Errors and Omissions Coverage

  • Anti-Money Laundering Certificate (If Selling ANY Life Insurance)

  • Valid Voided Check or EFT form to set up your Bank deposits. (Not required for Licensed Only Agents, LOA)

  • Supporting documents required for background questions

  • CMS/FFM Certification is required BEFORE requesting any Affordable Care Act (ACA) Carriers.

  • AHIP Certification is required BEFORE requesting any Medicare Carriers. (Discount with Aetna provided below)

If Doing Business as an Agency or LLC

  • Business needs to be licensed and registered with NIPR.

  • Business EIN and National Producer Number 

Agent Information

States currently Licenced with
As Individual, LOA, or Business (Agency)
Yes or No

Voided Check or Valid EFT Form

If doing business as an Individual or a Business, this is REQUIRED. Failure to submit with a Voided check or EFT form will result in delays in Onboarding and Contracting.

Banking/ Deposit

Bank Authorization


Errors & Omissions

Anti-Money Laundering

AHIP Certification

CMS/FFM Certification


Agent Profile

We need a headshot photo from you. This photo will be used as your professional profile picture for our company website, social media pages, as well as your ID badge and business cards.

For best results

  • Find a solid, clutter free background 

  • Use natural light (do not use flash)

  • Have a family member or friend take your photo, no selfies please!

  • Smile and look into the camera lens

Background Information

If yes, please answer the questions below:

If yes, please answer the questions below:

If yes, please answer the questions below:

If yes, please answer the questions below:

If yes, please answer the questions below:

If yes, please answer the questions below:

If you answered any questions “yes,” provide an explanation that includes dates, actions and descriptions. Attach additional paper if necessary.

Communication Consent

TCPA Consent.

I consent and approve of receiving calls, SMS messages (including text messages) and emails from Impact Legacy Group, their affiliated companies, or their agents, representatives, or affiliates or anyone calling on their behalf for any and all purposes arising out of or relating to our mutual relationship, at any telephone number, or physical or email or electronic address you provide us or at which you may be reached. Telephone numbers you provide include those you give to us, those from which you or others contact us, or which we obtain through other means. You agree we may contact you in any way, including SMS messages (including text messages) calls using pre-recorded messages or artificial voice, and calls and messages delivered using automatic telephone dialing systems (auto‐dialer) or an automatic texting system. Automated messages may be played when the telephone is answered, whether by you or someone else. In the event that an agent or representative calls, he/ she may also leave a message on your answering machine, voice mail, or send one via text. IMPACT LEGACY GROUP, OUR AGENTS, REPRESENTATIVES, AFFILIATES AND ANYONE CALLING ON OUR BEHALF MAY USE SUCH MEANS OF COMMUNICATION DESCRIBED IN THIS SECTION.

Agent Agreement


Agent Authorization


What Happens Next 

  1. Once submitted, and Verified, you will receive access to all “Impact Resources” followed by an email with contracting invitations for the carriers/ product affiliated with your agency. - Familiarize yourself with the resources and Look out for your contracting Links.(Check Spam/Junk) Be sure to complete All carrier contracts ASAP

  1. Impact Contracting Team receives all completed contracts, processes and sends them to the carrier for final approval and a writing number. - Connect with our Impact community and continue training

  1. You will receive an email from the individual carrier with Your writing number and login information to their specific carrier portal.  - Navigate to carrier portals, Save Login information and begin serving clients

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply.


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