How to Apply

How to Apply

Getting coverage in place isn't difficult or complicated.

Please have the following information available to complete your application.

  • Licensure Information – A copy of each active state license and certification you hold.
  • Previous Insurance Information – A copy of your current Declarations Page (if you are currently insured).

Apply Online Today

For Agents and Brokers

  1. Click below to select the correct application:

    Applications for Connecticut, Florida and Nevada


    Applications for All Other States

  2. Complete, print and sign the application.
  3. Send it to PSIC Dental:
    • Please follow the submission instructions found on the PSIC Dental application.

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