Group / Individual Product Agent Information Form

Thank you for your interest in Superior Vision’s Group & Individual Product offerings. If you are not appointed by NGL to sell products offered by Superior Vision you will need to complete the agent appointment packet that will be sent to you shortly after receipt of this form. Completion of this form is all that is required to sell the individual product if you are currently appointed by NGL to sell group products.

* Denotes required field.

Product Offerings:*

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Additional Non-Resident State(s):

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(if applicable)

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