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

It's easy to apply online. Get started today.


For Agents and Brokers

  1. Click below to select the correct application:

    Applications for Connecticut, Florida and Nevada

    Applications for Minnesota

    Applications for North Dakota

    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.

Need Office Coverage?

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