Fidelity & Guaranty NY Agent Licensing & Appointment Contracting Forms

421 So. 9th St., Suite 222
Lincoln, NE 68508

If you can read the Adobe file that is embedded on this page, simply print, complete, and fax that form to 866-866-2232 or 732-792-9777. You are NOT required to send proof of Errors and Omissions (E&O) coverage.

If you are unable to view the embedded Adobe file on this page, click this link to download it.

Incorporated in 1962, Fidelity & Guaranty Life of New York offers a diverse portfolio of annuities and life insurance products to help families and businesses achieve secure financial futures. Fidelity & Guaranty Life of New York is a member of the Old Mutual plc group of companies.