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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Do not delete"]
[null,null,null,null,"PERSONAL LINES",null,null,null,"V19",null,"Date of Request:"]
[null,null,null,null,"New Appointment",null,null,null,null,null,"Sales Executive:",null,"Chris Haines",null,null,null,"Yes"]
[null,null,null,null,"Intake Form",null,null,null,null,null,"Regional Sales Director:",null,"Pete Cricton",null,null,null,"No"]
[]
[null,"LICENSING INFORMATION & OTHER"]
[null,"If the Agency is open for Other Lines of Business:  BI or BSI provide the TRV Code"]
[null,"Attach Agency License"]
[null,"Attach W9",null,null,"Required Tax ID:"]
[null,"Is Principal licensed?  (If yes attach license)"]
[null,"IF NO:","Who is the Licensed Producer? (attach license)",null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[null,"AGENCY INFORMATION"]
[null,"Agency Legal Name:"]
[null,"DBA as Filed with DOI: (If NY or PA attach DBA filing):"]
[null,"If agency is a Prime under a Master provide Master Code:",null,null,null,null,"0DFX9O"]
[null,"Name of the Master Agent:",null,null,null,null,"Local Edge (formerly NBS)"]
[null,"Are the commissions paid to the Master? Series 900  Yes/No"]
[null,"Is the EFT / banking information controlled by the Master? Series 900"]
[null,"Addresses:"]
[null,null,"Physical Business Location",null,null,null,null,null,"Mailing Address (Shows on Dec Page)"]
[null,"Street"]
[null,"City "]
[null,"State"]
[null,"Zip"]
[null,null,"Is this a Home Address?  If yes it will not be listed on Find an Agent"]
[null,"Agency Phone #:"]
[null,"Agency Fax #:"]
[null,"Agency Website URL:"]
[null,"Who is the Agency Principal?",null,null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[null,"Who is the Agency contact for the LexisNexis Process?",null,null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[null,"Who is the Agency contact to complete the Netappt/Concierge?",null,null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[]
[null,"LexisNexis JNODE*:                                                "]
[null,"Does the agency have an existing active LexisNexis JNODE*? Provide:                                               ",null,null,null,null,null,null,null,null,"SEE JNODE VERIFICATION - ATTACH VERIFICATION RESPONSE WITH YOUR FORM."]
[null,"*If JNODE above is active, The agent or SE can email  AGENCY LEGAL NAME AND ADDRESS to confirm their Jnode is active and updated (expect 24 hour turn around).  SE please attach verification response with this form when sending to SSPRODPI@travelers.com",null,null,null,null,"Email to verify JNODE with LexisNexis (DO NOT USE FOR STATUS UPDATES):  insuranceunderwritingsupport@lexisnexisrisk.com"]
[null,"Did agent apply with LexisNexis - if yes, provide temp node or contract ID from Lexis"]
[null,"**If NO Jnode - SE to review Onboarding process and LexisNexis Guide with agent prior to application.",null,null,null,null,"The below link to the LexisNexis Online Portal where your agent can apply and view the status of the LexisNexis credentialing process."]
[null,null,null,null,null,null,"https://insurancesolutions.lexisnexisrisk.com/idslogin/newagent/"]
[]
[]
[null,"AUTOMATION"]
[null,"Agency's System Administrator Information:",null,null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[null,null,null,null,null,"Phone:"]
[null,null,"If the agency is appointed with other TRV business lines does the administrator have an existing TRV User ID?",null,null,null,null,null,"TRV USER ID:"]
[null,"Florida agents:  Will the agent be writing in other states? (For Homeowner access)",null,null,null,null,null,null,null,null,null,null,null,null,"Can be collapsed for any Region not appointing in FL"]
[null,"Does Agency have an Agency Management System?  If NO skip to next section:"]
[null,"     Provide Agency Management System Name and Vendor "]
[null,null,"Does the agency have an IVANS account?  If yes Provide:",null,null,null,null,null,"IVANS:"]
[null,null,"If No IVANS do you want TRV to request one for you?  Yes/No"]
[null,null,"Does the agency want policy download? Yes/No",null,null,null,"Yes"]
[null,null,"Does the Agency want Commission Download?  Yes/No",null,null,null,"Yes"]
[null,null,"Who is the Agency contact for Download:",null,null,"Name:"]
[null,null,null,null,null,"Email:"]
[null,null,null,null,null,"Phone:"]
[]
[null,"OTHER INFORMATION FOR REGIONAL PROCESSING - TRV Sales Executive to Complete"]
[null,"If this request is part of a larger initiative - provide name: "]
[null,"Will the agent be enrolled in CCC  (Yes/No):"]
[]
[]
[]
[null,"CONCIERGE PROCESSING AND STATE SPECIFIC INSTRUCTIONS"]
[null,"Massachusetts Only:",null,null,"# of Stamps",null,null,null,null,null,null,null,null,null,"Can be collapsed for any Region not appointing MASS"]
[null,null,null,null,"Is a Mass E-stamp needed? "]
[null,null,null,null," If YES: Vertafore or Singlepoint"]
[]
[]
[]
[]
[]
[null,"Attachments Required:  COPY OF THE AGENCY LICENSE AND PRINCIPAL’S LICENSE, W9, Master approval if applicable, NY & PA DBA Certificate if applicable"]
[null,"FOR AGENCY STAFF NEEDING APPOINTMENT, THE AGENCY PRINCIPAL WILL BE PROMPTED TO ADD THEM ON THE NETAPPOINT APPLICATION. "]
[null,"This form must be accompanied by RSD approval as well as response from LexisNexis that the jnode has been verified."]
[]
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