By completing this form, you are registering your company to be a Travel Retailer and to offer travel insurance under the Limited Lines Travel Insurance Producer (LLTIP) licenses of the companies participating in this Registry, subject to the review and approval by the participating companies.

As referred to in this Certification Form, certain words are defined as follows:

Employees means employees of your company whose duties include offering and disseminating travel insurance.

Agents means other companies (including sole proprietorships and independent contractors (IC)) whose employees are involved with offering or disseminating travel insurance on your company’s behalf or are otherwise involved with the business of travel insurance.

Travel Retailer means a business entity that makes, arranges or offers travel services and may offer and disseminate travel insurance as a service to its customers on behalf of and under the direction of a Limited Lines Travel Insurance Producer (or in some states, Limited Lines Travel Insurance Agent).

1. I certify that I, my Company, my company’s Employees, and my company’s Agents have completed the Travel Advisor (Travel Retailer) Training Program and have reviewed all training materials provided and will act in accordance with the training. Future updates to the training program will be completed as required, and all future Employees and Agents of my company will also complete the Travel Advisor (Travel Retailer) Training Program, will review all training materials provided and will act in accordance with the training (including any updates thereto).
2. Under Section 1033 of Title 18 of the United States Code, it is a criminal offense for an individual who has been convicted of a felony involving dishonesty or breach of trust or any violation of 18 U.S.C. § 1033 to willfully engage or participate in the business of insurance unless that person has first obtained the written consent of the appropriate regulatory official (Prohibited Person). Further, it is a criminal offense for any person to willfully employ, or willfully permit, such "Prohibited Persons" to participate in the business of insurance without the required written consent. A "Prohibited Person" may not be an officer, director or employee of an insurance agency or an insurance company, an agent, solicitor, broker, consultant, third party administrator, managing general agent, or subcontractor representing an insurance agency or insurance company who engages in or transacts the business of insurance. I certify that no existing or future Employees or agent is a Prohibited Person and will not permit any Prohibited Person to perform any services or other obligations involving insurance under this registration.

By clicking Continue, I warrant and represent that:

1. I, on behalf of myself and my company’s employees and agents as well as my com’s future employees and agents on whose behalf I am signing, have read, understand, and agree in full to make all of the above certifications.
2. I have the authority to make these certifications on behalf of my company.
3. If at any time any of the above certifications are no longer true, cannot be made, or are not wished to be made, I, my company’s Employees, and my company’s Agents will immediately (a) cease to offer and disseminate travel insurance and (b) notify the relevant Limited Lines Travel Insurance Producers of our cessation.
4. My company agrees to comply with each individual Limited Lines Travel Insurance Producer’s specific rules and marketing guidelines as provided by that company.
5. My company will indemnify, defend and hold harmless USTIA and its member companies for all claims and damages due to a breach of any certification, representation, warranty, or other agreement included herein.