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
- Click below to select the correct application:
Applications for Connecticut, Florida and Nevada
Applications for All Other States PSIC:
- Complete, print and sign the application.
- Send it to PSIC Dental:
- Please follow the submission instructions found on the PSIC Dental application.