Berkley Aspire New Agents

Please allow 15-20 minutes to complete the application.

You will need the following documents (missing documents will delay the process):

Copy of Agency License
Copy of E&O dec page (please note all Berkley companies require $5m/$5m limits)
Copy of W9

If you would like to view the producer agreement form you can download it here.

Step 1: Agency Information

“*” indicates required fields

Legal Agency Name (Must match the name on agency license.) *

DBA Name (must be state recognized)

National Producer Number *

Physical address *
Street address

Address Line 2 (Suite, Unit)

City

County

State

Zip

Mailing address *

Same as Physical address
Street address

Address Line 2 (Suite, Unit)

City

State

Zip

Entity type *

FEIN *

Date Agency Was Founded *

Website

Phone Number *

Extension

Fax Number

Step 2: Principal & Agency Contact

Contract Signatory Name *

Contract Signatory Email *

Primary Contact Name *

Primary Contact Email *

Broker Principal Name *

Broker Principal Email *

Licensing Contact Name *

Licensing Contact Email *

Accounting Contact Name *

Accounting Contact Email *

Portal Administrator Name *

Portal Administrator Email *

Step 3: Agency Operations

Do you currently do business with other Berkley companies? *

Which ones?

Does your agency have additional locations? *

Do you have a small or “select” business unit? *

Do you use Customer Service Centers (CSCs)? *

Are you familiar with Berkley Marketplace? *

Approximate total commercial premium in the last year

What percentage of that is E&S?

List the 3-5 carriers with which you place the most business *

Step 4: Financial Information

Billing address *
Street address

Address Line 2 (Suite, Unit)

City

State

Zip

Commissions Contact Name *

Commissions Contact Email Address *

Bank Account Holder Name (if different than Agency Name)

Type of Account

Bank Routing Number

Repeat Routing Number
This is to confirm the routing number of the bank.

Bank Account Number

Repeat Account Number
This is to confirm the account number of the bank.

Step 5: Compliance Questions

During the past (5) years, has your agency acquired/merged with another agency or has your agency changed names? *

Please provide details:

Is your agency engaged in, owned by, associated or affiliated with, or controlled by any other interest? *

Please give details:

Has any member/officer/licensee of your agency ever been convicted of violating or been found to have violated a state insurance law or regulation by any court or regulatory authority? *

Please give details:

Has any licensee who is a member/officer/employee of your agency had a license suspended or revoked in the last 5 years? *

Please give details:

Are there any judgments or pending or threatened litigation within the past 5 years, exceeding $10,000, against your agency or any employees? *

Please give details:

The Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C. §§ 1033-1034 (“the Act”), prohibits a person who has been convicted of any criminal felonies involving dishonesty or breach of trust, or who has been convicted of any offense described in the Act from engaging in the business of insurance, unless that person first obtains the written consent of the insurance regulatory official authorized to regulate the Producer and that said consent expressly references the Act. The “business of insurance” means the writing of insurance, including all acts necessary or incidental to writing of insurance.

To comply with the Act, does your agency conduct a comprehensive civil and criminal background check of all prospective employees or contractors who will be engaged in the business of insurance to verify they meet the terms of the Act? *

Does your agency require all employees and contractors engaged in the business of insurance to affirm that they meet the terms of the Act? *

Step 6: Upload Required Documents

Upload E&O Dec Page

Upload W9

Upload Agency Licenses
(Maximum of 5 files can be uploaded to the below field)

File types allowed are image files, pdf, xls.

Step 7: Review & Sign Producer Agreement

I verify that the Agent Set Up Information is true and accurate *

I verify that the Agent Set Up Information is true and accurate. *

By signing this, I confirm that I am authorized to sign this form. *

Use your mouse to write the signature above.
Please leave this field empty.