SIU New Agent Application

Step 1: General Agency Information

Physical Address
Mailing Address
Billing Address
Additional Locations Address
Format of Tax ID is XX-XXXXXXX
Agency Licenses
(min limits of $1,000,000)

Step 2: Agency Principals, Officers, Contacts

Agency Principal Information
License Information
Home Address
Agency Primary Contact Information
Other Contact Information
E-Policy Delivery and Accounting Statement Delivery Information

E-POLICY DELIVERY

SIU's Electronic Policy Delivery System is designed for the Independent Agency to received documents via email in a PDF format. View, save, print and email Personal, Commercial Property & Casualty and Commercial Transportation documents, in lieu of receiving a paper version. Included in the e-Policy Delivery are the Agent and Insured copies of Policies (New and Renewal) and Endorsements. 

By default all policy correspondence will be sent to the email address provided for the agency principal. If you would like to add a second email address to receive policy correspondence or would like to edit the information we have on file please complete the section below: 


ACCOUNTING STATEMENT DELIVERY

SIU Accounting is now paperless! Statements are available on the first business day of every month online at www.siuins.com. 

By default all accounting correspondence will be sent to the email address we have on file for the agency principal. If you would like to add a second email address to receive accounting correspondence or would like to edit the information we have on file, please complete the section below.

Step 3 : Market & Premium Information

This information will be used to develop a personalized communications plan to ensure timely notification
of relevant product information.
Total Written Premium (total written premium to include auto, personal lines, and commercial)
E&S Premium and Markets Information
%
What are you interested in writing with SIU? (indicate both current interest or potential)
Indicate your premium percentage breakdown (total percentage should be 100%)
%
%
%
%
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Banking

Step 4 : Documentation Attachments

Please attach all documents requested below in a PDF or Word formats.