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Annual Compliance Questionnaire for 2024
Annual Agent Compliance Questionnaire 2024
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Name
(Required)
First
Last
Email
(Required)
Agency Name
NPN
(Required)
Website
I hereby agree, understand, and have read all the terms stated in the most current Compliance Guide 2024
(Required)
Yes
No
Do you currently purchase leads for sales purposes?
(Required)
Yes
No
If Yes, please provide the name(s) of the provider(s)
Do you participate in telephonic sales for Medicare Advantage and/or Part D Plan?
(Required)
Yes
No
If yes, do you understand and follow the latest CMS guidelines which include the Medicare disclosure, recording of the call, and the use of approved compliant sales scripts?
(Required)
Yes
No
I hereby agree, I understand the Marketing guidelines and what materials require prior approval from carriers and CMS
(Required)
Yes
No
I hereby agree, I understand that I agree to know and follow CMS and Carrier guidelines that are required by me to be compliant and Ready-To-Sell Medicare Advantage and/or Part D plans.
(Required)
Yes
No
TERMS OF SIGNATURE I understand that providing my electronic signature by typing my name below constitutes a legal signature confirming that I certify the accuracy and truthfulness of the information provided in this form.
(Required)
Date
(Required)
MM slash DD slash YYYY
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