Get Appointed today to sell Fidelity Security Life Individual Disability Insurance

  Documentation and Checklist

Agent Information Kit: Request an Agent Information Kit today from our Support Team. This includes product literature and all contracting forms so you can become appointed and begin selling FSL Individual DI. Please call 866-747-5434 to obtain an Agent Information Kit.

Appointment Checklist: Please send us the following:
1) Agent Data Sheet, 2) an Individual Producer Agent Agreement 3) a W-9 Tax Form 4) a copy of your current Resident State License and 5) in some states you should also include a check payable to FSL for your States Appointment Fee (in general fees vary between $5 and $40).


  5 Easy steps to get appointed and contracted today
  • CLICK HERE to download the “Agent Data Sheet” and “W-9″ forms - Complete both forms and Fax them to our Licensing Department at 954-421-4185 (along with a copy of your state license)

  • Schedule a call with us: send an email with your contact information (name and cell number) and best time to reach you to: AgentContracting@nonStandardDi.com

  • Your friendly Broker / Agent Support Team will contact you to discuss contracting and commissions schedule for various agency levels – They will then email you the appropriate contract – CLICK HERE to see a sample base commission schedule and contract for producers.

  • Complete agency contract and mail it with your appointment fees (if applicable)
  • In some states you should include a check payable to Fidelity Security Life Insurance Company (FSL) with the Appointment fees required by your state‚Äôs Department of Insurance (see state fees below).

    Visit your State Insurance Department’s site for current fees, forms and appointment process (see NAIC’s State DOI).

    Please state whether the licensed agent and / or the agency should be appointed in the State(s) where you do business. The appointment fees should be submitted for both the individual and the agency if your state requires both to be appointed in order for your agency to be paid commissions.

    If you are already appointed for FSL through another GA for another product, please indicate as such and we will confirm your appointment.


  • A Marketing Associate, will contact you for a Welcome Conference call. He will provide you with an Express 10-minute training on our plans and procedures and provide with some tips regarding how to start prospecting for target customers.


You are now ready to start selling non-standard Disability Income Insurance!

eZ-DI is brought to you by Risk Insurance and Reinsurance Solutions a global provider of specialized insurance solutions
Insurance products are underwritten and administered by Fidelity Security Life Insurance Company, Kansas City, MO. Fidelity Security Life Insurance Company has been rated A- (Excellent), based on an analysis of financial position and operating performance , by A.M. Best Company, an independent analyst of the insurance industry.
This site generally represents the products underwritten by Fidelity Security Life Insurance Company, 3130 Broadway, Kansas City, MO 64111, but it is not a complete representation of them without the Policy's Explanation of Benefits, Exclusions and Limitations. Domicile: Missouri. NAIC No. 71870. Authorized to transact insurance in all states except NY.
Platinum Plus Group SD-28 / Policy Form No. M-4021; Platinum Plus Individual SD-29 / Policy Form No. M-4022; Platinum/Silver Group DI-139C & DI-139D / Policy Form No. M-4004; Platinum/Silver Individual SD-16 & SD-17 / Policy Form No. M-4012 /Policy Form No: M-00167/ Platinum eZ-Select Group SD-32, SD-33 / Policy Form No. M-4024; Platinum eZ-Select Individual SD-34 & SD-35 / Policy Form No. M-4025; Blue Group DI-141A; Blue Individual SD-18 & SD-19.