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Click ‘Get Form’ to open the FR-19 in the editor.
Begin by filling out the top section with the date of request and listing each insurer company you are authorized to issue Maryland Insurance Certifications for. Ensure you sign and date this section.
Select the appropriate action from the options provided: New Request, Account Change, Account Deletion, Add Insurer Association, or Remove Insurer Association.
Enter your USERID assigned by MVA and your Producer License Number issued by MD Ins Admin.
Complete your personal information including your name, phone number, agency name, address, and email address.
List up to six insurers you are authorized to issue certifications for, including their NAIC codes.
Acknowledge the terms regarding remote access by signing and dating at the bottom of the form.
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Rule 19. Required Joinder of Parties - Law.Cornell.Edu
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