Producer name:
Producer home address:
Applicant individual background questions
If you responded yes to any of the individual background questions, please explain all in detail under separate cover and attach appropriate documents (I.e. official court records, etc.), and email to

I hereby certify all of the information herein is accurate and complete and any falsification, misrepresentation or omission of information from this form may result in withholding or withdrawal of any state appointment by Markel Service, Incorporated for its affiliated insurance companies. Any fines or penalties resulting will be the responsibility of the applicant.

Admitted Insurance products and services written or provided by subsidiaries and affiliates of Markel Corp. including, but not limited to: Markel Services, Inc.; Markel Insurance Company; Markel American Insurance Company; FirstComp Insurance Company, SureTec Insurance Company, SurTec Indemnity Insurance Company, and Essentia Insurance Company.

Individual producer appointment application

This form is applicable for all Markel affiliated Admitted Insurance Companies.

An appointment with the applicable state insurance department will not be made with one or more of the Markel affiliated Admitted companies until an account has been solicited with that company, unless state law requires otherwise.

By completing this form you agree to make us aware if you need an appointment before any account solicitation.