Annual Agent Certification

01

Certification Identity

Required

Confirm the agent, agency, certification year, and record ownership before continuing.

Agent ID

Certification year

Assigned administrator

First name

Last name

Agency

02

Profile Confirmation

Required

Confirm current contact and business information. Changes will update the agent profile after agency review.

Email

Phone

Resident state

NPN

Agency writing number

Business mailing address

Has your contact or business information changed since your last certification?

No changesExisting information is current. Changes enteredAgency review is required. Need assistanceAdministrator follow-up requested.

03

License Review

Required

Review resident and nonresident licenses. Add states only when a current license is active or pending renewal.

Are all listed licenses active and in good standing?

YesAll licenses are current. Renewal pendingOne or more renewals are underway. Issue to reviewAgency assistance is needed.

04

AHIP Certification

Conditional

Capture annual AHIP status for Medicare agents and upload proof when available.

AHIP status

Completion date

Score

AHIP certificate

No file selected

AHIP evidence is uploaded securely, versioned, and linked to this agent certification and its audit history.

05

Errors & Omissions Coverage

Required

Confirm active coverage and expiration so WorldOS can create renewal alerts before coverage lapses.

E&O carrier

Policy number

Expiration date

Coverage certificate

No file selected

06

Carrier Selection & Readiness

Required

Confirm which carrier relationships should remain active, be added, or be reviewed during this certification cycle.

UnitedHealthcareMaintain or renew relationship. HumanaMaintain or renew relationship. AetnaMaintain or renew relationship. Blue Cross Blue ShieldMaintain or renew relationship. SCANMaintain or renew relationship. Other carrierEnter details below.

Carrier additions, removals, or contracting notes

Do you have any carrier certification or Ready-to-Sell items still outstanding?

NoNo known outstanding items. YesAgency follow-up is required. UnsureRequest a status review.

07

Changes & Support Requests

Optional

Use one consolidated request area instead of separate buttons for every possible change.

Primary request type

Request details

08

Additional Documents

Conditional

Upload only items that changed, expired, or were specifically requested.

License copy

No file selected

W-9

No file selected

Void check / direct deposit

No file selected

Agent Attestation

Required

The agent confirms the accuracy of this annual certification and authorizes agency review and processing.

I certify that the information provided is true and complete to the best of my knowledge. I understand that inaccurate or expired information may delay contracting, certification, commissions, or Ready-to-Sell status. I authorize my agency to review, retain, and transmit required information to authorized FMOs, carriers, and service providers for legitimate business purposes.

Electronic signature

Date signed

10

Review & Submission

Final

Review overall readiness. The single Submit action routes the certification to the assigned agency administrator.

AgentAgent record loading—

Certification yearNot selectedAnnual certification

Assigned reviewerNot assignedAgency administration

Completion0%Required sections tracked automatically

AHIPNot selectedAnnual Medicare readiness

E&O expirationNot enteredRenewal alerts begin automatically

Submission creates an agency review task, locks the attestation version, notifies the assigned administrator, and places this record in the certification work queue.

A

Agency Review

Administrator

Verify documents, record corrections, approve readiness, and prepare the authorized FMO package.

Review decision

Reviewer

Review date

Correction request

Internal agency notes