Become an AIA Agent

Become an AIA Agent

Please take the time to fill out and submit both the Producer Application and the Personal Financial Statement forms below. Once you have submitted the application one of our team members will contact you. In the meantime, should you have any questions, please don't hesitate to call our support team at 800.935.2245.

Producer Application

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  • Has any disciplinary action, including but not limited to, refusal, suspension, revocation, ever been taken by any regulatory agency in any state against you or any business with which you have been directly connected?

  • Have you ever been convicted of, pleaded guilty or no contest to any misdemeanor or felonty or currently have pending misdemeanor or felony charges filed against you?

  • In connection with your application for a producer underwriting agreement (“Agreement”) with Allegheny Casualty Company and/or International Fidelity Insurance Company, you understand and agree that AIA Holdings, Inc. (“AIA”) may obtain credit, consumer or investigative reports (“Reports”) concerning you and/or your business entity(ies) (“you/your”). Such reports would including information about your character, general reputation, personal characteristics and mode of living, finances, credit history/scores, employment records, education, qualifications, criminal records, driving records, credentials, and/or credit and indebtedness, and may involve personal interviews with sources such as supervisors, friends, neighbors, associates, public record or various federal, state, or local agencies.

    By "Checking Agree" below, you hereby authorize the AIA to obtain such Reports from any such agency/entity which provides such reports. You further authorize any ongoing procurement of such Reports at any time during the term of the Agreement, if any.

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  • For Maine Applicants Only

    Upon request, you will be informed whether or not an investigative consumer report was requested, and if such a report was requested, the name and address of the consumer reporting agency furnishing the report. You may request and receive from us, within 5 business days of our receipt of your request, the name, address and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing an investigative consumer report concerning you. You also have the right, under Maine law, to request and promptly receive from all such agencies copies of any reports.

    For New York Applicants Only

    You have the right, upon written request, to be informed of whether or not a consumer report was requested. If a consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report.

    For Washington Applicants Only

    If we request an investigative consumer report, you have the right, upon written request made within a reasonable period of time, to receive from us a complete and accurate disclosure of the nature and scope of the investigation. You have the right to request from the consumer reporting agency a summary of your rights and remedies under state law.

  • For California, Minnesota or Oklahoma applicants only: A consumer credit report will be obtained through Business Information Group, Inc. (BIG), P.O. Box 541, Southampton, PA, 18966 Telephone (800) 260-1680. www.bigreport.com.

  • For California applicants only.

    If you chose to receive a copy of the consumer report, it will be sent within three (3) days of the employer receiving a copy of the consumer report and you will receive a copy of the investigative consumer report within seven (7) days of the employer’s receipt of the report (unless you elected not to get a copy of the report). BIG’s privacy practices with respect to the preparation and processing of investigative consumer reports may be found at www.bigreport.com (link at bottom of page entitled, “Legal/Privacy”).

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Personal Financial Statement

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  • 1. Cash

  • 2. Stocks, Mutual Funds, 401k, Iras

  • 3. Real Property

  • $
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  • $

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  • 4. Vehicles


  • 5. Other Assets

    Jewelry, gunds, atvs, antiques, personal property, business interests, etc
  • 6. Other Liabilities

    Credit Cards, student loans notes, etc



  • 7. Other