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Additional Upline Referral Form

In order for you to have access to in force data written through your upline BGAs, IMOs or BDs, each upline firm must be set up on NIC.  To refer your upline BGA, IMO or BD complete the form and submit it to NIC.  NIC will contact the firm directly and use its best efforts to get the firm set up.  Once the firm is set up you will see the in force data for business you wrote through the upline firm.  Note; NIC assumes you are identified, by the carrier, on the policy records.  

YOUR INFORMATION

BGA/IMO/BD INFORMATION

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