Information Required by Agents
Important!
All PBS Insurance Underwriting corporation Brokers, please assist us with the following information to update our records:
You must supply us with a certified identification number on a W-9 "request for taxpayer identification number."
The following information is needed:
- Your complete agency name (including inc. or corp. if incorporated).
- Please advise us as to whether you operate as an individual, partnership, or corporation. (Indicate in the upper right hand corner of the W-9 form).
- Provide us with your current taxpayer identification number (FIN) on the "W-9" form. For individuals your TIN is your social security number, for corporations it would be your federal tax ID number, partnerships would use individual social security numbers.
- Sign and date the form.
- Please complete agency profile.
- Also please enclose a current copy of your individual P&C license. If a corporation, a copy of your corporate license.
- Return the W-9 form, copy of license and agency profile to our office.
Download the necessary forms below:
Surplus Lines Affidavits by State:
*Indicates the Generic Declination Form
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