We market our policies through a network of insurance professionals. Those who share our underwriting philosophy; embrace a thoughtful, consultative approach to risk mitigation; and always take the opportunity to do the right thing, are invited to learn more about joining our distribution team.
In order to keep our records up-to-date and to comply with various state insurance regulations, we require all Agencies to complete the Origin Specialty Non-Exclusive Producer Agreement.
Origin Producer Questionnaire and Agreement
W9Form
We urge you to review, execute and return to us as soon as possible to
ddjordjevic@Origin-specialty.com.
Please be sure to include the following information in your Producer Registration Packet:
- Completed “Origin Specialty Producer Questionnaire and Agreement”
- Completed W-9 Tax Form
- Copy of your Home State Insurance License
- Copy of current E&O Declarations Page
- Copy of current Fidelity Declarations Page
We will return a fully executed copy of the Agreement to you for your files. If you have any questions, please feel free to contact us at ddjordjevic@Origin-specialty.com with any questions or comments.