GROUP SUBMISSION REQUIREMENTS 1. Employer Application UW2 3/08 or Ohio Universal App1210 2. Certificate of Non-Discrimination 3. Employee Application UW3 1/09 - enrollment/waivers 4. EFT Sign-Up AD43 (optional) 5. Most recent prior carrier invoice 6. Starmark proposal/prescreen information - please circle the plan selected 7. Quarterly wage/tax or OBES - please reconcile: indicate PT, FT or terminated (incl. date) and add new hires 8. Company's business check for 1st month's premium made payable to Starmark
Licensing Appointment Questionnaire - complete and submit with: Copy of license Copy of E&O deck page W-9 Voided check should you reequest direct deposit
May Insurance Services, Inc. is a BrokerNet, Inc. affiliate.
