Required Docs — Prodigy Innovative Ventures

What You'll Need

Onboarding Checklist

Review everything required before submitting. All items are included in the form below — fill out what applies to you and upload each document.

PDB Report

ProducerDB background check report

Zip Folder — All Licenses

All lines of authority listed

E&O Certificate

Errors & Omissions insurance certificate

Voided Check

For direct deposit setup

W9 Form

Complete the fillable form below

FFM Certificate

Federally Facilitated Marketplace certification

MI License

Required if contracting ACA (digital copy not accepted)

Licensing & Appointment Acknowledgement

Sent separately via Adobe Sign

List of Appointments & Current Upline

Separate checklist document required

Release Letter(s) — Completed & Signed

One for each upline you are currently with

Ambetter Reciprocal Release

Required only if currently contracted with Ambetter

Direct Deposit Form

Complete the fillable form below

W9 — Request for Taxpayer Identification

Complete all fields. Certification signature required.

Legal Name (as shown on your income tax return) *

Business Name / DBA (if different from above)

Federal Tax Classification *

Individual / Sole Proprietor C Corporation S Corporation Partnership Trust / Estate LLC Other

Street Address *

City *

State / ZIP *

Taxpayer Identification — Enter SSN OR EIN

Social Security Number (SSN)

Employer Identification Number (EIN)

Certification

Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number; (2) I am not subject to backup withholding because I am exempt or have not been notified by the IRS of a failure to report all interest or dividends; (3) I am a U.S. citizen or other U.S. person as defined in IRS instructions.

Full Legal Signature (Type your full name) *

Date *

Direct Deposit Authorization

Used to set up your commission payments. Routing and account numbers are typically found on a voided check.

Account Holder Name *

Bank Name *

Routing Number (9 digits) *

Account Number *

Account Type *

Checking Savings

Authorized Signature (Type your full name) *

Date *

Document Uploads

Upload all applicable documents. PDF, JPG, or PNG files accepted. Max 10MB per file.

PDB Report

PDB Report Click to select file

License Zip Folder (All Lines)

License Zip Folder PDF, JPG, or ZIP

E&O Certificate

E&O Certificate Click to select file

Voided Check

Voided Check Click to select file

FFM Certificate

FFM Certificate Click to select file

MI License (ACA contracting only)

MI License Physical scan required

Release Letter(s)

Release Letter(s) One per current upline — multi-select OK

Ambetter Reciprocal Release (if applicable)

Ambetter Reciprocal Release Only if contracted with Ambetter

Package Received

Your onboarding documents have been submitted to the PIV contracting team. We'll be in touch within 1–2 business days. Questions? Call us at (850) 547-6423.

Questions About Contracting?

Our team walks every agent through the process. Call us and we'll get you set up fast.

Call (850) 547-6423