Broker data form 2026

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The document is a Broker Data Sheet for Securian Life Insurance Company and Minnesota Life Insurance Company, detailing the information required for brokers to apply for appointment. It includes sections for product information, broker details, errors and omissions insurance, broker-dealer information, and declarations regarding the broker's background. Additionally, it outlines privacy policies under the California Consumer Privacy Act and provides disclosures related to the Fair Credit Reporting Act. The document emphasizes the importance of accurate information submission and includes a release authorization for background checks.

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Click ‘Get Form’ to open the broker data form in the editor.
Begin by filling out the 'Product Information' section. Indicate the lines of business you are requesting appointment for, such as Life, Annuity, or Employer plan (401K).
In the 'Broker Information' section, enter your full legal name as it appears on your insurance license. Include your date of birth, Social Security number, and email address for confidential information.
Provide your residential and business addresses along with preferred telephone and fax numbers. Ensure all fields are accurately filled to avoid delays.
Answer the questions regarding Long Term Care products. If applicable, list the states where you will sell these products and attach any required training certificates.
Complete the 'Errors and Omissions Insurance Information' section by providing carrier name, effective dates, and company contact details.
Finally, review all responses in the 'Broker Declaration' section carefully before submitting to ensure accuracy.

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