Everything your clients need to apply to become a Conventus member-owner is available on this page. The Conventus Broker Kit includes: Application Instructions Conventus Application and Supplemental Documents Broker Agreement/Questionnaire (brokers must sign and return immediately) What is a PDF? Download Adobe Acrobat Reader
	Click here or the image above to download the Broker Kit

Supplemental Applications <click on application name to view>
	Non-Physician Health Care Provider App.
	Group Practice Application
	Emergency Medicine Supplemental App.
	Supplemental Prior Acts App.
Claim Information (Loss Run) Request Forms <click on application name to view>
	Generic Claims Info Request Form
	Princeton Ins. Co. Authorization to Release Claims History
	MIIX Adv./MD Adv. Authorization to Release Claim Info
	MIIX Group Authorization to Release Claim Info

For more information or to submit an account for consideration, please contact Lyn Winters at (877) 444-0484 Ext. 221 or via e-mail: lwinters@nipgroup.com