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Adams-Moore, LLC 1441 Heather Lane Charlotte, NC 28209 Phone 704-522-9228 Fax 704-522-9118 www.adams-moore.com CONTRACTING INSTRUCTIONS NOTE: If commissions will not be paid to you individually please contact Nancy Crisp at 704-522-9228 ext. 18 for additional instructions. PLEASE PROVIDE THE FOLLOWING WITH YOUR COMPLETED PAPERWORK · Resident License · E & O coverage declaration page · AML Certification – provide documentation of current anti-money laundering course unless the training was taken through LIMRA ~ please be sure to include the date where indicated on the application · Voided check copy for direct deposit Please return the fully completed paperwork to: nancy@adams-moore or fax to 704-522-9118 Variable and Fixed Annuities ♦ Indexed Annuities ♦ Immediate Annuities ♦ Life Insurance ♦ Impaired Risk Underwriting Long Term Care Insurance ♦ Disability Insurance ♦ Structured Settlements ♦ Wealth Transfer Concepts For Home Office Use Only APPROVED DISAPPROVED Date Signature AGENT APPOINTMENT/LICENSING APPLICATION PERSONAL INFORMATION p Male p Female Name: Last First Middle p 1-12 Mos p 3-5 Yrs p 1-3 Yrs p 5 Yrs & Over Residence Address City State Zip Social Security Number Date of Birth E-Mail Telephone Numbers: Business ( ) ______________________ Fax ( ) __________________________ Home ( )_________________________ List your resident addresses for the past five years if not covered above: Address City State Zip How Long p 1-12 Mos p 3-5 Yrs p 1-3 Yrs p 5 Yrs & Over p 1-12 Mos p 3-5 Yrs p 1-3 Yrs p 5 Yrs & Over BUSINESS INFORMATION Business Name: Business Address: (This will be used as the mailing address unless otherwise indicated) Are commissions to be paid to Agency/Corporation/Partnership? Yes p No p If Yes, give Tax ID # Are you an officer of this Agency/Corporation? Yes p No p Is this entity incorporated? Yes p No p Please attach Agency License. Do you have authority to sign on behalf of this Agency/Corporation/Partnership? Yes p No p Please provide a copy of your E&O Policy Schedule Page reflecting your per claim, aggregate and DEDUCTIBLE amounts. Do you have E&O insurance on yourself? Yes p No p If "No", are you covered under your firm's policy? Yes p No p (Continued on reverse) Business Background If the answer to any of these questions is YES, please refer to Guidelines For Business Background Section. 1. Have you EVER had any complaints made against you, been fined, refused a license, suspended or placed on probation, reprimanded, or entered into a consent order, or are you currently under investigation by any insurance department, the NASD, SEC, or any other regulatory authority? 2. Have you EVER filed bankruptcy under State or Federal Bankruptcy Law, had salary garnished or had any liens or judgments outstanding against you? 3. Have you EVER had any appointment or contract terminated by an insurance company or managing general agent for any alleged cause? 4. Other than a minor traffic violation, have you EVER been convicted of, pled guilty or "no contest" to, or served probation for, any offense including DUI, DWI or involvement with illegal substances? 5. ARE YOU A CITIZEN OF THE UNITED STATES? If no, please provide country of Citizenship and a copy of VISA, passport or alien registration receipt card or other proof showing USCIS authorization to work in the U.S. Employment History List your occupation/employment for the past 5 years: (include periods of unemployment) Employer's Name & Address From (Mo/Yr) To (Mo/Yr) Reason for Leaving Unemployment (City & State) From (Mo/Yr) To (Mo/Yr) Training/Industry Designations Ethics: please describe your ethics training in the last five (5) years: Please list any Professional or Industry Designations you currently hold or Professional Organizations of which you are a member: Have you ever had any anti-money laundering training in the last 12 months? p Yes, I hereby certify that within the last 12 months, I have taken an anti-money laundering training course approved for continuing education by the insurance regulators in my state of domicile or, sufficient to count toward my continuing education requirements under NASD rules. • Date Course Taken___________________________(Please attach a copy of the certificate of completion.) p Yes, I hereby certify that I have taken an anti-money laundering training course. (Please attach a copy of the certification of completion) p No, I have not taken any anti-money laundering training in the last 12 months. NOTICE TO AGENT: We must advise you that American Fidelity Assurance Company (AFA) strictly adheres to the Federal Violent Crime Control and Law Enforcement Act and the IMSA Principles. As part of our normal appointment procedure, an investigative consumer report and/or a home office report may be prepared on you. This report contains information obtained via personal interviews with your neighbors, friends, or others with whom you are acquainted. These inquiries usually concern information on your character, general reputation, personal characteristics, criminal background (if any) and mode of living. Upon your written request, we can provide you with additional information as to the nature and scope of the report. By signing this application, you are representing that all the information recorded above is true and correct to the best of your knowledge. Further, you are authorizing AFA to do any background investigation or prepare any report we deem necessary to allow you to represent AFA. If you misrepresent any material fact recorded above, it will be cause for refusal or revocation of the right to represent AFA and possible notification to any state regulatory authority. Signature of Agent Date BD-1027 (APN) Life Div 07/07 Guidelines For Business Background Section To properly underwrite your appointment application, it is imperative that you fully and honestly disclose to AFA all of the details of your "Yes" answer(s). For each "Yes" answer(s), please provide the information outlined below on a separate sheet of paper and attach it to your appointment/ licensing application. At the bottom of each attachment(s), please sign your name and date it. Question # 1: Regulatory Investigation l investigating regulatory body l date(s) of incident l carrier or agency involved l charge(s) l final disposition of investigation (reprimand, consent order, fine*, suspension*, probation*) product and/or market Keep for your file. l l provide copies of all pertinent documents * provide amount of fine and/or length of suspension or probation, copies of documents Question # 2: Bankruptcy l date(s) l type (personal/business) l Chapter (7, 11 or 13) l jurisdiction (federal or state court/district) l circumstances surrounding the bankruptcy, lien(s) or judgement(s) l provide copies of petition, discharge order Question # 3: Appointment Termination l date(s) l reason for termination l carrier or agency involved Question # 4: Criminal Offenses l date(s) l description of charge (misdemeanor, felony) l final disposition (acquittal, pled to a lesser charge, fine**, conviction**, dismissal**) l jurisdiction (federal, state or municipal court/district) ** provide amount of fine, time served, probation or suspension of sentence, copies of court documents CHECKLIST: (Items listed below MUST be submitted to properly process your appointment.) p - Appointment Fee p - Two (2) Signed Agreements p - Copy of Your License p - Signed Authorization for background investigation - M-2072 (FCRA) Rev 03/07 p - Copy of Agency License (If commissions are to be paid to p - Mail to: PO Box 25360, Oklahoma City, OK 73125 fax to 800-620-8974 Agency or Corporation.) OR e-mail to firstname.lastname@example.com p - Copy of your E & O Schedule of Benefits page Corporate Philosophy American Fidelity Assurance Company ("AFA") is, and always has been, 100% committed to high standards of ethical conduct by all our distributors, because we believe in doing business the right way. In our opinion, the certification process promoted by the Insurance Marketplace Standards Association ("IMSA") represents the right way to do business. IMSA was founded by the American Council of Life Insurers to assure high standards of operation among the life insurance companies and to improve market conduct through the continuing improvement of compliance standards. As a result of poor market conduct activities among a few companies, and increased litigation, the life insurance industry believes it is better to take proactive action to improve our market conduct activities while we still can, before the federal government decides that we are unable to regulate ourselves. AFA became IMSA certified in June 1999. However, prior to certification, to demonstrate our commitment to this worthwhile endeavor, on January 21, 1998, AFA adopted and implemented as Corporate Policy, the IMSA Six Principles of Ethical Market Conduct, IMSA Code and Twenty-Seven Statements of Policy based upon the Principles and Code. In the same spirit of self-regulation, AFA's interpretation of the insurance-related provisions of the Federal Violent Crime Control and Law Enforcement Act of 1994, prevents AFA from appointing any representative with a prior felony conviction. This Act applies not only to insurance carriers but to TPA's and individual brokers as well. We believe our corporate philosophy will result in fewer customer complaints, improved customer satisfaction, higher persistency because the business was sold properly, better company perception by customers, fewer customer service problems and improved profitability. Authorization to Conduct Background Investigations I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge about me, to furnish bearer with any and all information in their possession regarding me, including my driving records in connection with an applicant for employment or license. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written authorized request. I understand this authorization is to be part of the written employment application or agent appointment application which I sign. I have been given a stand alone, consumer notification that a report will be requested and used for the purpose of evaluating me for employment, promotion, reassignment or retention as an employee or for a license, required by law, to consider an applicant's financial responsibility. Print name___________________________Signature______________________________ Date of Birth________________________SSN________________________________ (For Identification purposes only) Print former name_______________________________________________________ (Through Marriage or Other) M-2072 (FCRA3) REV 3/07 AGENT NOTIFICATION American Fidelity Assurance Company discloses to you an investigative background report is being obtained for the purpose of: evaluating you for employment, promotion, reassignment or retention as an employee or; determining your eligibility for a license that is required by law and to consider your financial responsibility. This report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living from public record sources or through personal interviews with your neighbors, friends or associates. You may also have a right to request additional disclosures regarding the nature and scope of the investigation. This background report is being furnished by: Business Information Group, Inc. 1105 Industrial Highway Southampton PA 18966 800-260-1680 1 Summary of Your Rights Under the Fair Credit Reporting Act The Fair Credit Reporting ACT (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "Consumer Reporting Agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you - such as where you work and live, if you pay your bills on time, and whether you have been sued, arrested, or filed for bankruptcy - to creditors, employers, landlords and other businesses. The FCRA gives you specific rights in dealing with CRAs, and requires them to provide you with a summary of these rights as listed below. You can find the complete test of the FCRA, 15 U.S.C. 1681 at the Federal Trade Commission's website (http://www.ftc.gov). You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you - must give you the name, address, and phone number of the CRA that provided the report. You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a company/person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving the notice of the action. You are also entitled to one free report every twelve (12) months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you a fee of up to eight (8) dollars. You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must reinvestigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs - to which it has provided the data - of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any changes. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change. 2 Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove data from your file that is accurate unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source. You can dispute inaccurate items with the source of the information. If you tell anyone - such as a creditor who reports to a CRA - that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you have notified the source of the error in writing, they may not continue to report the error. Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven (7) years old; ten years for bankruptcies. Access to your file is limited. A CRA may provide information about you only to those who have a need recognized by the FCRA - usually to consider an application you have submitted to a creditor, insurer, employer, landlord, or other business. Your consent is required for reports that are provided to employers, or reports containing medical information. A CRA may not report to your employer, or prospective employer, about you without your written consent. A CRA may not divulge medical information about you without your consent. You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete and return the CRA form provided for this purpose. You must be taken off the list indefinitely. You may seek damages from violators. You may sue a CRA or other party in state or federal court for violations of the FCRA. 3 The FCRA gives several different federal agencies authority to enforce its provisions. FOR QUESTIONS OR CONCERNS REGARDING PLEASE CONTACT Federal Trade Commission CRA's creditors and others not listed below Consumer Response Center - FCRA Washington, DC 20580 Phone: 202-326-3761 National banks, federal branches/agencies of Office of the Comptroller of the Currency foreign banks (word "National" or initials "N.A." Compliance Management, Mail Stop 6-6 appear in or after bank's name) Washington, DC 20219 Phone: 800-613-7643 Federal Reserve System member banks (except Federal Reserve Board national banks, and federal branches/agencies of Division of Consumer & Community Affairs foreign banks) Washington, DC 20551 Phone: 202-452-3693 Savings associations and federally chartered Office of Thrift Supervision savings banks (word "Federal" or initials "F.S.B." Consumer Programs appear in federal institution's name) Washington, DC 20552 Phone: 800-842-6929 National Credit Union Administration Federal credit unions (words "Federal Credit 1775 Duke Street Union" appear in institution's name) Alexandria, VA 22314 Phone: 703-518-6360 Federal Deposit Insurance Corporation State chartered banks that are not members of the Division of Compliance & Consumer Affairs Federal Reserve System Washington, DC 20429 Phone: 800-934-FDIC Air, surface, or rail common carriers regulated by Department of Transportation former Civil Aeronautics Board of Interstate Office of Financial Management Commerce Commission. Washington, DC 20590 Phone: 202-366-1306 Department of Agriculture Activities subject to the Packers and Stockyards Office of Deputy Administrator - GIPSA Act, 1921 Washington, DC 20250 Phone: 202-720-7051 4 The information on this page applies only to residents of the State of California who are obtaining information from the Consumer Reporting Agency that was utilized to perform the background investigation obtained by American Fidelity. Cal Civ Code § 1786.22. Time and manner of supplying information (a) An investigative consumer reporting agency shall supply files and information required under Section 1786.10 during normal business hours and on reasonable notice. (b) Files maintained on a consumer shall be made available for the consumer's visual inspection, as follows: (1) In person, if he appears in person and furnishes proper identification. A copy of his file shall also be available to the consumer for a fee not to exceed the actual costs of duplication services provided. (2) By certified mail, if he makes a written request, with proper identification, for copies to be sent to a specified addressee. Investigative consumer reporting agencies complying with requests for certified mailings under this section shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative consumer reporting agencies. (3) A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be provided by telephone, if the consumer has made a written request, with proper identification for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to the consumer. (c) The term "proper identification" as used in subdivision (b) shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver's license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with the information described above, may an investigative consumer reporting agency require additional information concerning the consumer's employment and personal or family history in order to verify his identity. (d) The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information furnished him pursuant to Section 1786.10. (e) The investigative consumer reporting agency shall provide a written explanation of any coded information contained in files maintained on a consumer. This written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under Section 1786.22. (f) The consumer shall be permitted to be accompanied by one other person of his choosing, who shall furnish reasonable identification. An investigative consumer reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumer's file in such person's presence. AMERICAN FIDELITY ASSURANCE COMPANY AFAmeriLife Division PO Box 268923, Oklahoma City, OK 73126-8923, (405) 524-8444, (800) 735-9701 DIRECT DEPOSIT FORM FOR AGENT COMMISSIONS Please complete the following information, tape a void check in the space provided, sign and date the form and return this agreement to us. Your name and address must be pre-printed on the void check and must match the name in which commission checks are currently being made payable to. We will continue to mail your commission statement to you. Please remember, commission checks are only generated if the month-end amount is greater than $50.00. This will remain the same for direct deposit amounts. Agent Name: ______________________________ Agent #: ______________________ Name of Bank: ____________________________ Account #: _____________________ Circle one: Checking Savings Please tape a void check (or copy of void check) here: I hereby authorize American Fidelity Assurance Company to deposit my commissions into the above named bank account: Signed: ______________________________ Date: ___________________ Please return this form to: American Fidelity Assurance Company, Attention Commission Accounting, P O Box 268923, Oklahoma City, OK 73126-8923 AFAmeriLife® Division Producer Agreement This Agreement is made and entered into on this ______ day of _____________________, ________, by and between American Fidelity Assurance Company, an Oklahoma corporation (hereinafter referred to as "Company") and __________________________________________, an individual, partnership, limited liability company, or corporation (hereinafter referred to as "Producer"). (PLEASE PRINT) SECTION I Contract. You are authorized, subject to the Company's rules and regulations, to solicit applications for Insurance Products of the DEFINITIONS Company listed in the Compensation Schedule(s) attached hereto In this Contract: "You" or "Your" refers to You, the Company's and identified as Exhibit A or additional exhibits only in those Producer, Agent, Agency or Broker; "We", "Our" or "Us" refers states or jurisdictions in which You are licensed. You do not have to the Company; and "Insurance Products" refers to the insurance an exclusive right to sell any particular Insurance Product of the policies, riders, plans or contracts offered by the Company. Sub- Company in any particular territory nor do You have the right to Producers refers to any agent under You directly or indirectly knowingly solicit business from any group, trade or education affecting the commissions under this Contract. associations which have previously endorsed the Company without the Company's prior written authorization. You shall be SECTION II responsible for obtaining and maintaining the necessary licenses and appointments to sell the Company's products in the states in EFFECTIVE DATE which You operate, whether resident or non-resident. Subject to 2.01 INITIAL EFFECTIVE DATE. the advance written approval of the Company, You are authorized This Contract is effective on the later of the day of to recruit and sponsor to the Company applications to appoint ____________________________, __________, or the first other licensed Sub-Producers. The Company reserves the right day You are properly licensed, appointed or approved to sell the to refuse to accept business from any of Your Sub-Producers Company's Insurance Products. and to refuse to contract with any proposed Sub-Producers or to terminate with or without cause any Sub-Producers contract and 2.02 DELAYED EFFECTIVE DATE. can do so without terminating or violating Your Contract. With respect to business in any state where You are not properly licensed, appointed or approved to sell the Company's Insurance You are responsible for assuring that any Sub-Producers reporting Products, this Contract will not take effect until You are properly business through You become fully informed as to the provisions licensed, appointed or approved to do so. and benefits of each Insurance Product offered by the Company for which Sub-Producers solicit applications. You further agree SECTION III to represent such policies adequately and fairly to prospective purchasers and act in compliance with the Company's policies YOUR TERRITORY and procedures. 3.01 APPOINTMENT. You are hereby appointed as a non-exclusive Producer, Agent, When a Sub-Producer's appointment or license is terminated, Agency or Broker for the Company. this will be treated as his/her termination of employment with You. The Company will be free, at its choosing, to enter into a 3.02 EXCEPTED PRODUCTS. new contract with any terminated Sub-Producer without violating Certain Insurance Products offered by the Company from Your Contract. time to time may be marketed only through other persons or organizations. These Insurance Products will not be available 4.02 INDEPENDENT. to You and You will not receive any commissions or other rights You are an independent contractor. Nothing contained in this under these Insurance Products. Contract or in the rules and regulations of the Company shall be constructed to create the relationship of employer and employee In addition, by Your signature below, You acknowledge that the between You and the Company. You shall be free to exercise Your Company does not offer and shall not accept Earned Income own judgment as to the persons from whom You shall solicit Credit ("EIC") business. applications for the Insurance Products of the Company listed in Your Compensation Schedule and the time, place and manner of solicitation. However, the Company may, from time to time, SECTION IV prescribe rules and regulations respecting the conduct of Your YOUR AUTHORITY business, but not interfering with Your freedom of action. 4.01 GENERAL AUTHORITY. Further, You will not be treated as an employee for purposes of You have the authority, responsibility and rights stated in this the Federal Insurance Contribution Act, the Social Security Act, 1 the Federal Unemployment Tax Act or income tax withholding. Bliley Act and related federal and state laws regarding the The filing and payment of self-employment and income taxes privacy of the individual, non-public personal information of with the Federal and appropriate state government(s) are Your Our insureds. Based on the foregoing, You agree and warrant sole responsibility. You agree to comply with the requirements that You are aware of the requirements of the Gramm-Leach- of the Federal and appropriate state government(s) with respect Bliley Act, and related federal and state laws, regulations, rules to the filing and payment of self-employment and income taxes and requirements, and agree that You shall: 1) comply with all on any remuneration from the Company. such federal and state laws, rules, regulations and requirements in the performance of Your obligations and duties as a Producer You are solely responsible for the compensation of Your Sub- for the Company; and 2) restrict Your use of the non-public Producers and persons in Your employ, including compensation personal, medical and/or financial information that You obtain, on business issued before termination of employment. You collect, receive or otherwise access on behalf of the Company agree to indemnify and hold the Company harmless from any pertaining to Our insureds solely for the purpose of performing loss, costs, liabilities, or damages which may be incurred by the services and obligations in Your capacity as a Producer the Company as a result of Your failure to properly compensate for the Company; and 3) take all reasonable steps to protect Your Sub-Producers, employees and other representatives not the non-public personal, medical, and/or financial information otherwise referenced in this Contract. pertaining to the Company's insureds, to the extent You acquire and possess such information. 4.03 RESERVATION OF RIGHTS. You further agree that You will not: 1) sell, share, trade or disclose The Company, without specifying the cause, reserves the right to: any non-public personal, medical and/or financial information a) discontinue writing, and/or b) withdraw, substitute, change or pertaining to any individual insured of the Company, who may alter any of the Company's Insurance Products or premium rates seek to obtain or who has previously obtained any Insurance used by the Company, and/or c) withdraw from doing business Products or services under this Contract for personal, family, or within Your designated territory, if any, and/or d) discontinue household purposes, to any individual or entity, including Your Your marketing of any of the Insurance Products listed in Your affiliates, employees, agents and representatives, except those Compensation Schedule(s). The exercise of these rights will be having a need to know or access such information to allow You to effective immediately upon notice to You by the Company. perform Your duties and obligations required under this Contract on behalf of the Company in Your capacity as a Producer for 4.04 SPECIFIC LIMITATIONS. the Company; and/or 2) take any actions that will cause the You are not authorized by or on behalf of the Company to: Company to be in violation of any federal or state privacy laws a. Incur any debt or obligation on behalf of the and regulations. Company; or, b. Make, alter or discharge any contract or policy; or, Accordingly, You agree to hold harmless and indemnify the c. Waive any forfeiture; or, Company from any claims, loss, costs, damages, fines or d. Waive payment in cash; or, liabilities of any kind which may result from Your disclosure or e. Extend the time for payment of any premium or any other non-permitted use of any non-public personal, medical accept payment of any past due premium; or, and/or financial information pertaining to Our individual insureds f. Extend the days of grace of any policy; or, in contravention of this Contract and all applicable state and g. Waive or approve evidence of good health of federal privacy laws and regulations. You further understand and insurability; or, agree that if the Company is aggrieved by Your breach of the h. Receive any money due or to become due to the provisions of this paragraph 4.05 and/or the requirements of any Company, except the first premium or first federal and state privacy laws and regulations, the Company shall installment of premium on applications obtained be entitled to immediate injunctive relief, any other remedies by or through You; or, afforded by law and the Company may immediately terminate i. Represent the Company in any manner, except as this Contract pursuant to Section VIII, paragraph 8.01. permitted by this Contract. If You do any of the above unauthorized acts, the Company 4.06 PROTECTION OF INDIVIDUALLY may terminate this Contract and declare Your conduct to be IDENTIFIABLE HEALTH fraud or wrongdoing in violation of Section VI, paragraph 6.07. The Company may also seek any other remedy it deems INFORMATION. As a Producer appointed by the Company, You acknowledge appropriate. and agree that You will comply with the requirements of the Health Insurance Portability and Accountability Act of 1996, and 4.05 PROTECTION OF INDIVIDUAL any other applicable law regarding the Privacy of Individually Identifiable Health Information of Our insureds for any of the PRIVACY/CONFIDENTIALITY Company's Insurance Products that are covered by the Health REQUIREMENTS. Insurance Portability and Accountability Act of 1996, and any As a Producer appointed by the Company, You are obligated to other applicable law regarding the Privacy of Individually comply with the requirements of the Federal Gramm-Leach- Identifiable Health Information. 2 (a) Definitions: (4) You agree to report to the Company any use or When used in this Contract as defined terms, the following terms disclosure of the Protected information not shall have the meanings set forth below: provided for by this Contract of which You become aware; and "Privacy Rule" for the purpose of this Contract shall mean (5) You agree to ensure that any Producers or the Standards for Privacy of Individually Identifiable subcontractors, including Sub-Producers, to Health Information at 45 CFR Part 160 and Part 164, Subparts whom You provide, with the Company's prior A and E. written approval, Protected Information received from, or created or received by You on behalf "Protected Information" for the purpose of this Contract shall of the Company agree to the same restrictions mean any information about the Company's insureds, and conditions that apply through this Contract enrollees or subscribers or about individuals who apply to You with respect to such information; and for coverage with the Company, regardless of whether the (6) You agree at the request of the Company to provide information is individually identifiable. the Company access to Protected Information in the format requested by the individual, unless the "Secretary" for the purpose of this Contract shall mean the Protected Information is not readily producible Secretary of the Department of Health and Human Services in such format, in which case it shall be or his designee. produced in a readable hard copy format; and (7) You agree to make any amendment(s) to "HIPAA Rules" for the purpose of this Contract shall mean Protected Information that the Company directs the collective privacy, transaction and security regulations in accordance with 45 CFR 164.526 for as long promulgated pursuant to the Health Insurance Portability as the Protected Information is in Your possession and Accountability Act, as codified at 45 CFR parts 160, or und e r Your re a s ona ble control; and 162, and 164. (8) You agree to make internal practices, books, and records, including policies and procedures and "Individual" for the purpose of this Contract shall have the Protected Information, relating to the use and same meaning as the term "individual" in 45 CFR § 160.103 disclosure of Protected Information received from and shall include persons who qualify as a personal the Company, or created or received by You on behalf representative in accordance with 45 CFR § 164.502 (g). In of the Company available to the Secretary or other general, an Individual is the person who is the subject of regulatory officials as directed by the Company, Protected Health Information. in a time or in a time and manner designated by the Secretary or other regulatory official, for "Security Standards" for the purpose of this Contract shall purposes of the Secretary or other regulatory mean the Security Standards set forth at 45 CFR parts 160, official determining the Company's compliance 162, and 164, to be effective no later than April 20, 2005, with the Privacy Rule or other applicable law; and as they exist now or as they may be amended. (9) You agree to document such disclosures of Protected Information and information related "Transaction Standards" for the purpose of this Contract to such disclosures as would be required for shall mean the Standards for Electronic Transactions set the Company to respond to a request by an forth at 45 CFR, parts 160 and 162, as they exist now or as individual for an accounting of disclosures of they may be amended. Protected Information and provide this "HHS" for the purpose of this Contract shall mean the information to the Company as it may request Department of Health and Human Services. from time to time. (10) If You conduct any HIPAA Standard Transaction Terms used, but not otherwise defined, in this paragraph 4.06 for or on behalf of the Company, You shall shall have the meaning as those terms in the Privacy Rule. comply, and shall require any subcontractor or subagent conducting such HIPAA Standard (b) Obligations and Activities of Producer : Transaction(s) to comply, with each applicable (1) You agree to not use or disclose Protected requirement of Title 45, Part 162 of the Code of Information other than as permitted or required Federal Regulations. You shall not enter into, by this Contract or as required by law; and or permit Your subcontractors or subagents (2) You agree to use appropriate safeguards to to enter into, any agreement in connection prevent use or disclosure of the Protected with the conduct of Standard Transactions Information other than as provided for for or on behalf of the Company that: by this Contract; and i. changes any definition, Health Information (3) You agree to mitigate, to the extent practicable, condition, or use of a Health Information any harmful effect that is known to You of a use or element or segment as described in the HHS disclosure of Protected Information by You in Transaction Standard Regulation (45 CFR § violation of the requirements of this Contract; 162.915 (a)); or and ii. adds any Health Information elements or 3 segments to the maximum defined Health cure the breach and end the violation Information Set as described in the HHS within the time specified by the Company; Transaction Standard Regulation (45 CFR § or, 162.915 (b)); or ii. Immediately terminate this Contract iii. uses any code or Health Information if You have breached a material term elements that are either marked "not used" of this Contract and cure is not i n t h e H H S Tr a n s a c t i o n S t a n d a r d 's possible; or, implementation specifications or are not iii. If neither termination nor cure is i n t h e H H S Tr a n s a c t i o n S t a n d a r d 's feasible, the Company shall report the implementation specifications (45 CFR § v i o l a t i o n t o t h e S e c r e t a r y. 162.915 (c)); or (3) Effect of Termination. iv. changes the meaning or intent of any of the i. Except as provided in paragraph 4.06 HHS Transaction Standard's implementation (e)(3)(ii), upon termination of this specifications (45 CFR § 162.915 (d)). Contract, for any reason, You shall (11) To the extent You create, receive, maintain, return or destroy all Protected or transmit electronic protected health Information received from the Company, or information ("PHI"), no later than April 20, created or received by You on behalf of 2005, You shall: the Company. This provision shall apply to i. implement administrative, physical and technical Protected Information that is in the safeguards that reasonably and appropriately possession of Your Producers or protect the confidentiality, integrity, and subcontractors, including Sub- availability of the electronic PHI that You Producers. You shall retain no copies create, receive, maintain or transmit on behalf of the Protected Information. of the the Company as required by the Security ii. In the event that You determine that Standards. returning or destroying the Protected ii. Ensure that any agent, including a subcontractor, Information is infeasible, You shall to whom You provide electronic PHI agrees provide to the Company notification of the to implement reasonable and appropriate conditions that make return or safeguards to protect the PHI. destruction infeasible. Upon the Company's iii. Promptly report to the the Company any Security satisfaction that return or destruction of Incident, as determined by You, involving Protected Information is infeasible, You P H I o f w h i c h Yo u b e c o m e a w a r e . shall extend the protections of this (c) P e r m i t t e d U s e s a n d D i s c l o s u r e s b y P r o d u c e r. Contract to such Protected Information Except as otherwise limited in this Contract, You may and limit further uses and disclosures use or disclose Protected Information solely for the of such Protected Information to purpose of performing Your obligations and duties those purposes that make the return or as a Producer for the the Company, provided that such use destruction infeasible, for so long as or disclosure would not violate the Privacy Rule Yo u m a i n t a i n s u c h P r o t e c t e d or any other applicable law if done by the Company or Information. the minimum necessary policies and procedures of (f) Miscellaneous. the Company. (1) Regulatory References. A reference in this (d) Further Restrictions on Use and Disclosure by Contract to a section in the Privacy Rule Producer. You shall limit the use and disclosure means the section as in effect or as amended. of Protected Information as the Company may (2) Amendment. The parties agree to take such instruct to comply with the Company's obligations action as is necessary to amend this Contract under the Privacy Rule and any other applicable from time to time as is necessary for the law. Company to comply with the requirements (e) Term and Termination. of the Privacy Rule and the Health Insurance (1) Term. The Term of this Contract shall be Portability and Accountability Act of 1996, effective as of the date listed in paragraph 2.01 or and any other applicable law. paragraph 2.02, whichever is applicable, of this (3) Survival. The respective rights and obligations Contract and shall terminate as provided in of Producer under the Privacy of Individually paragraph 8.01 of this Contract or for cause as set Identifiable Health Information paragraph forth in paragraph 4.06(e)(2) of this Contract. shall survive the termination of this Contract. (2) Termination for Cause. Upon company's (4) Interpretation. Any ambiguity in this Contract shall knowledge of a material breach by You, be resolved to permit the Company to comply the Company may, at its discretion, either: with the Privacy Rule and any other applicable law. i. Provide an opportunity for You to cure the breach and end the violation or terminate this Contract if You do not 4 SECTION V any administrative, regulatory, legal or disciplinary proceedings against You or any of Your Sub-Producers relating to any license YOUR DUTIES issued to You or any of Your Sub-Producers as pertaining to any 5.01 SOLICIT INSURANCE. of Your duties under this Contract. You shall actively solicit applications for the Company's Insurance Products for approval or disapproval by the Company, 5.05 COLLECTION OF FUNDS. collecting initial premiums in exchange for the official receipts All premium payments by insureds or proposed insureds shall furnished by the Company. All applications shall be dated in be by check or cashiers check payable to the Company. Neither the presence of the applicant with the date the application was You nor Your Sub-Producers are authorized to collect any check signed . You will mail or deliver the application, as well as the or cashiers check payable to You or Your Sub-Producers for entire gross premium collected, to the Company within fifteen premiums due to the Company. All initial premium collections (15) working days after the application is signed by the applicant. made by You or Your Sub-Producers shall be kept entirely Premiums paid by the policyowner after the initial premium shall separate and distinct from any other funds in Your possession, be payable directly to the Company. You will be responsible to and You shall forward all such funds to the Company within the Company for all monies and securities collected by You and fifteen (15) working days. In no case shall You make any use of such funds will be promptly remitted to the Company. If the first these funds. Should You withhold any funds, policies, receipts year's premium is payable in installments, You will collect only or other property belonging to the Company or to any applicant the first installment thereof. for insurance, this Contract shall be immediately terminable by the Company; and upon such termination, all first year 5.02 ALABAMA RELATED SALES. and renewable commissions and any other claims whatsoever For each sale of the Company's Insurance Products to accruing hereunder to You shall be forfeited in accordance with policyholders in the State of Alabama (regardless whether the Section VI, paragraph 6.07. application is physically taken in Alabama), You are required to: a. secure approval (signature) on the Company's 5.06 AVAILABLE PRODUCTS. Arbitration form from all individual insurance policy The solicitation of applications for the Company's Insurance applicants; and Products shall be restricted to the Insurance Products named b. submit the signed Arbitration form to the Company in the Compensation Schedule(s) attached hereto and such with the signed Acknowledgment form and other Insurance Products as may subsequently be added to the completed application. Compensation Schedule(s). Alabama resident applicants must elect arbitration to be considered an acceptable risk to the Company for all Insurance 5.07 PRODUCT DELIVERY. Products sold in that state. You and Your Sub-Producers shall promptly deliver all issued policies and contracts in accordance with the Company's rules. 5.03 OBSERVATION OF COMPANY 5.08 RETURN OF PREMIUM. RULES, ETC. If no policy or contract is issued on an application, then the whole You are responsible for Your actions and the actions of Your Sub- amount of all monies collected by You and Your Sub-Producers Producers. You and Your Sub-Producers and other employees shall be returned to the applicant by the Company. If the Company will observe and familiarize Yourselves with the submission and finds it necessary, for any reason, to cancel a policy or contract underwriting guidelines and rules and regulations of the Company, and return premium on said policy You shall repay the Company, as they may exist from time to time. The rules and regulations of the on demand, the amount of any commissions received on premium Company are hereby incorporated into this Contract by reference. charges returned, even if You have paid the commissions to Your You agree to follow any special instructions as may, from time to Sub-Producers. time, be given to You by an officer, actuary, attorney or underwriter of the Company; and You will also comply with all laws of the states in which You are licensed. Notice to the Producer's Principal 5.09 FUTURE SERVICES. shall be deemed to constitute notice to the Sub-Producer. You As part of Your duties, You shall assist in the maintenance and agree not to cause: a) any Producer appointed with Us or any renewal of all policies and contracts issued by the Company and representative of the Company to sever ties or relationship with perform such other duties as may be requested by the Company. the Company, or b) any policyowner or certificateholder to cancel Failure to do so may result in forfeiture of future commissions. his or her policy or certificate. You agree not to solicit or replace any business submitted by You whether or not You are appointed and/or contracted or terminated. You agree not to compete with 5.10 RECORD RETENTION. Us in any group containing any of Our policyholders. You agree to keep full and complete records of all transactions pertaining to any business submitted and accepted under this Contract and any and all other records that may be required by 5.04 REPORT LICENSURE ACTIONS any governmental entity or regulatory agency in connection with OR PROCEEDINGS. Your relationship with the Company, its insureds and the public. You shall promptly notify the Company of the institution of You shall preserve all books and records for a period of not less 5 than five (5) years, the first two (2) years of which shall be in Sub-Producers. You shall have no claim for commissions except an easily accessible place at Your principal place of business. as herein provided and shall not be entitled to reimbursement Thereafter, such records may be warehoused or stored, subject for any expenses unless the incurring of such expenses was to availability to the Company and to any Commissioner of authorized in writing in advance by the Company. Insurance within five (5) days of a request thereof. The Company has no obligation to You and Your Sub-Producers for commissions, compensation, expense allowance or any other 5.11 ADDITIONAL AGENCY DUTIES. form of compensation in connection with the services performed The additional provisions set forth below will apply to this and expenses incurred by Your Sub-Producers. You acknowledge Contract if You are a corporation, limited liability company, and agree that Your Sub-Producers shall look solely to You for partnership or any entity other than an individual: the payment of commissions or other compensation hereunder. Compensation shall only be paid to Your Sub-Producers as long You shall designate one or more individuals to deal with Us as You and Your Sub-Producers maintain an insurance producers on Your behalf. Such designation must be made by Your board license, and are appointed in the states in which You and Your of directors if You are a corporation; by any member if You Sub-Producers are required to maintain such license. are a limited liability corporation; or by any general partner if You are a partnership. In the absence of a designation, We may The commissions and any other compensation provided in this (but are not obligated to) deal with Your president or any vice Contract will be compensation in full for all services performed president (if You are a corporation); any member (if You are a and all expenses incurred by You. You will pay to Us on demand limited liability corporation); or any general partner (if You are any compensation paid to or retained by You to which You are not a partnership). You agree to inform Us of any changes in Your entitled under the terms of this Contract. In case of any provision legal structure, and of any changes in Your officers, members requiring a refund of commissions or other compensation, We or partners. You also agree to inform Us of any transfer of Your may, at Our election, debit Your account for the amount of the stock, membership or partnership interests. Upon receipt of such refund without demand or notice, or may demand the refund, or information, We may elect to terminate this Contract upon five both, but debiting Your account in such manner will not relieve (5) days written notice to You. You of Your obligation to make the refund. While You are an active Producer, should Your commission earned under this 5.12 GOOD FAITH. Contract fall below $300.00 for any single contract year, the You agree to perform all of Your duties under this Contract in Company shall retain the right to automatically terminate this utmost good faith. Contract pursuant to Section VIII, paragraph 8.01. SECTION VI 6.02 COMMISSIONS FOR PRODUCER COMPENSATION OF RECORD. A policyholder may request a Producer of Record change. The Company, in its sole discretion and judgment, will settle any 6.01 COMMISSIONS. dispute regarding Producer of Record designation status. The While this Contract is in force, You will be paid commissions Company will allow the current Producer of Record thirty (30) based on the amount of premiums received in cash by the days to secure written proof from the policyholder or employer Company on policies and contracts issued from applications that the policyholder or employer does not wish to change for insurance solicited by You and/or Your Sub-Producers, its designated Producer of Record before a final decision is provided (1) Your name appears on the application as Producer, made. Removal as Producer of Record, in and of itself, will not or (2) the name of any of Your Sub-Producers appears on the terminate this Contract. Upon removal, You shall be entitled to application as Producer. Your commission rates and other terms receive any renewal commissions on business sold by You. are set forth in the Compensation Schedule(s) attached as Exhibit A. The Company may change the Compensation Schedule(s) from time to time as it sees fit, but the new schedules will only 6.03 LIMITS. apply to business written by You or Your Sub-Producers after Commissions will be payable only on insurance maintained the Company gives You notice of the change. Commissions due in force by payment of cash premiums, and no commission is and payable to You shall be computed and paid no less than payable on premium waived or commuted by reason of death monthly on premiums received and posted by the Company or disability. No first year or renewal commissions will be on policies covered by this Contract which are produced by paid on any temporary extra premium because of underwriting You and/or Your Sub-Producers whose relationships to You considerations. are properly established and authorized by Us, so long as the minimum commissions earned in any prior commission payment 6.04 "AS PAID" BASIS. cycle equals or exceeds $25.00. Any commission earned for All commissions will be payable on an "as paid" basis. For any commission cycle that is or remains below $25.00 will purposes of this Contract, "as paid" means We will pay Your be paid by the Company the next commission cycle after the commissions according to the mode in which the premium is commission balance equals or exceeds $25.00. All commissions paid to the Company, except that the Company reserves the in Schedule(s) A or additional schedules of this Contract shall be right to limit the commission paid on any one case to $10,000 reduced by the amount which the Company pays directly to Your on any modal premium collected on that case and pay the 6 remaining commission on that case in excess of $10,000 in a k. provided the Company's information or materials to manner mutually agreed to between the parties. No amount of a n y c o m p e t i t o r o r p o t e n t i a l c o m p e t i t o r. commission will be due and owing to You until the Company has Termination for cause will result in the forfeiture received the premium in cash to which the commission applies, of vested compensation. the policy has been issued and any necessary policy or riders have been properly executed and received by the Company. 6.08 YOUR COMPENSATION. Payment of all commissions on policies secured by You 6.05 RESERVATION OF RIGHTS. or Your Sub-Producers shall be made to You or Your Sub- The Company reserves the right to determine: a) the compensation Producers subject to paragraph 6.01. Neither You nor Your Sub- to be paid and to whom it shall be paid on reinstated or converted Producers shall have any further claim against the Company for policies and on policies which, in the Company's judgment, are commissions or otherwise. replacements of existing policies and b) classifications of policies for compensation purposes and the amount of compensation to be paid on plans not now covered in the Compensation Schedule(s). 6.09 COMPENSATION DEDUCTIONS. The Company may deduct from any monies due to You, which If a policy that You or Your Sub-Producers have sold is issued may be payable by the Company under this or any previous by the Company and then lapses for more than 45 days and is Contract, any amount which may be due to the Company subsequently reinstated, the Company will be relieved of the including any debit balance and including, but not limited payment of any future commissions for the resale of the policy to, amounts due under any prior Contract under which the unless the reinstatement application for such policy was procured Company has assumed liability from another company, and under by You, or Your Sub-Producers. paragraphs 6.01, 8.08 and 8.10 of this Contract. 6.06 DISPUTES. 6.10 LIEN. Should a dispute arise between You and another Producer over The Company is hereby given a first lien upon any amounts compensation, the Company will have the sole right to decide due You, Your estate, successors or assigns under this or any and settle the dispute. If the Company does so, its decision shall other Contract with the Company or its affiliates as security for be binding and conclusive on all parties. payment of any indebtedness owed to the Company by You or by Your Sub-Producers, if any. Any such indebtedness shall be 6.07 FORFEITURE OF FUTURE considered a personal debt to the Company and the Company COMPENSATION. shall have the right to collect said indebtedness from You, Notwithstanding any other provision of this Contract, including Your estate, successors or assigns. Any commissions, overrides those on vesting, no compensation will be due or payable after or other amounts advanced or otherwise paid to You before termination of this Contract if the Company discovers that during actually earned shall be an indebtedness under this paragraph. or after Your association with the Company You have: Any indebtedness owed by You to the Company under this Contract shall become immediately due and payable in full a. perpetrated any fraud or deceit upon any applicants, upon demand by the Company and any unpaid balance shall insureds or the Company; or, bear interest payable monthly at the published rate established b. misapplied the funds of the Company, an insured, by the Company commensurate with prevailing interest rates, or any applicant for insurance; or, until such date as the Company receives full payment from You. c. withheld any funds, policies, receipts, supplies or In the event of the termination of Your authority, the unpaid equipment belonging to the Company after We balance of Your indebtedness shall be immediately due and have made a demand for them; or, payable without demand or notice. If it becomes necessary to d. failed to truthfully and accurately report all take any legal actions to collect any such indebtedness, You relevant medical information known to You with agree to reimburse and/or indemnify the Company for all costs, respect to an applicant for insurance when expenses and attorneys fees that the Company may incur in required; or, recovering from You and/or Your Sub-Producers any property e. exceeded the specific limits of Your authority set or indebtedness belonging to or owed to the Company. forth in Section IV, paragraph 4.04, subparagraphs (a) through (i); or, f. done anything to influence a policyowner to cancel 6.11 INJUNCTION. or lapse his or her policy with the Company; or, You agree that if during this Contract or within two (2) years g. done anything to influence a Producer or employee after its termination, You do any of the acts described in Section of the Company to sever his or her relationship IV, paragraph 4.04, Section IV, paragraph 4.05, Section IV, with the Company; or, paragraph 4.06, or Section VI, paragraph 6.07 of this Contract, h. failed to fully cooperate with the Company to that damages, if any, and remedies at law for doing such acts investigate any complaint or dispute; or, would be inadequate. Therefore, in the event You do any such i. s u b m i t t e d a f r a u d u l e n t a p p l i c a t i o n f o r acts, the Company shall be entitled to an injunction, without the advancing of commissions; or, necessity of furnishing bond, restraining You from any such act. j. divulged the names of the Company's policyholders, You agree that any such act would result in continuing irreparable group payroll deduction accounts or producers to harm and damage to the Company, but nothing contained herein any competitor without Our permission; or, 7 shall be construed as prohibiting the Company from pursuing any other remedies available to it, including the recovery of Beneficiary designations should be indicated in this Contract. If damages from You. no designations are shown, Your estate will be Your beneficiary. If more than one Primary Beneficiary is named, payment shall be 6.12 CHARGEBACKS. made to them equally, share and share alike, or to the survivor of The current Company practice is not to apply chargebacks for them. If more than one Contingent Beneficiary is named, payment termination of Insurance Products. The Company reserves the shall be made to them equally, share and share alike, or to the right to implement chargeback of commissions at Our discretion survivor of them. The Contingent Beneficiary will participate in upon prior notification to You. the receipt of benefits only upon death of all Primary Beneficiaries prior to Your death. SECTION VII You may change any beneficiary without his or her consent, YOUR RIGHTS prior to designation of any irrevocable beneficiary, by filing a written request for the change with the Company's home office. The request will not be effective until the Company sends You 7.01 TRANSFERABILITY RIGHTS. notice that the request has been received. Once this notice has You may transfer, setover, convey or assign all or part of Your been sent, the change will relate back to and take effect as of business only upon the written consent of the Company. the date You signed the request. The Company will not be liable for any payments it makes before it acknowledges receipt of the request. A new designation of beneficiary terminates the interest 7.02 VESTING RIGHT of all previous beneficiaries. ON COMMISSIONS. Any commissions payable to You under the terms of the applicable Compensation Schedule(s) will immediately SECTION VIII vest, subject to the terms of: GENERAL PROVISIONS a. paragraph 6.01 of Section VI; b. paragraph 6.07 of Section VI; and c. paragraph 8.01 of Section VIII. 8.01 TERMINATION OF CONTRACT. Upon Your: a. death or dissolution; or, 7.03 RETIREMENT AND b. failure to comply with the Company's rules and regulations or the laws of any applicable state or DISABILITY RIGHTS. jurisdiction or the regulations of any applicable If You are an individual, upon Your written notice of retirement department of insurance; or, or upon the Company's determination that You are disabled, c. committing an act of fraud or wrongdoing as set and subject to provisions contained herein, the Company will forth in Section IV, paragraph 4.04, Section IV, continue to pay any total compensation due to You until You paragraph 4.05, Section IV, paragraph 4.06, Section VI, die. If You wish to do so, You may offer Your business to the paragraph 6.07, or any other section of this Contract; Company. If mutually acceptable terms can be agreed upon, the or, Company may purchase Your business and You will receive no d. allowing any insurance license of Yours to be revoked, further compensation under this Contract. suspended or non-renewed by any state; or, e. becoming bankrupt or insolvent; or, 7.04 RIGHTS UPON DEATH f. failing to comply with the terms and conditions of this or any other Contract with Us; or, WHILE ACTIVE. g. engaging in any sales practice which, in Our opinion, If You are an individual and You die while You are an active is injurious to the Company's name or business Producer (before retirement or disability), the Company will pay i n t e r e s t s , o r c o n d u c t i n g Yo u r s e l f , i n O u r any total compensation due to Your beneficiary(ies) as designated opinion, so as to injure the Company's standing or in this Contract, or Your estate until the death of all designated good name in the community or elsewhere; or, beneficiaries and their beneficiaries in succession. h. failing to comply with the proper collection of funds procedures as set forth in Section V, paragraph 5.04; 7.05 RIGHTS UPON DEATH or, i. failing to earn a minimum of $300.00 of commission WHILE RETIRED. during any single Contract year as set forth in If You are an individual and You die while You are receiving Section VI, paragraph 6.01. benefits under paragraph 7.03 of this Section VII, those The Company may for cause, automatically terminate this payments will be made to Your beneficiary(ies) as designated Contract by written notice to You or Your successors or assigns in this Contract, or Your estate until the death of all designated stating the cause of the termination. At any time, either You or beneficiaries and their beneficiaries in succession. the Company may terminate this Contract without cause on thirty (30) days written notice sent to the last known address 7.06 BENEFICIARIES. of the other. If You are an individual, this Contract shall If You are an Individual, Your Primary and Contingent 8 immediately terminate, without cause, upon Your death. If You are a partnership, the death of a partner shall not terminate this d. You will diligently and to the best of Your ability Contract, but it shall continue in force for new business only, ensure that the facts set forth by any potential insured in favor of the surviving partner(s), subject to the provisions in an application for insurance or coverage that You or of any written Partnership Agreement of which the Company Your Sub-Producers solicit are true and correct; and had prior written notice. If You are a corporation or limited e. You will fully inform each applicant that the Company liability company, this Contract shall immediately terminate upon will rely solely upon the applicant's representations in Your dissolution, bankruptcy, or insolvency. rejecting, conditionally accepting or contracting with the applicant, and that the subsequent discovery by the Upon termination, You shall immediately repay all indebtedness Company of material facts known by applicant and due to the Company, including all monies advanced to You, and either not disclosed or misrepresented on the application You shall deliver to the Company all funds, policies, property, can result in the rescission or cancellation by the records and agency supplies of every kind belonging to the Company of any contract entered into in reliance Company. In the event of termination of this Contract, one thereof; and hundred (100%) percent of future commissions will be payable f. You further agree and understand that an individual to You unless commissions have been forfeited to the Company shall not be accepted for coverage under the Company's pursuant to Section VI, paragraph 6.07, Section VIII, paragraph Insurance Products, unless and until the applications 8.22 or the amount does not meet the minimum amount listed in are reviewed and approved by the Company; and Section VI, paragraph 6.01. g. You will make no representation whatsoever with respect to the nature or scope of the benefits of the Company's Insurance Products except through and by 8.02 YOUR REPRESENTATIONS means of the written material prepared and furnished to You for that purpose by the Company and that You AND WARRANTIES. shall have no authority to and will not purport to make You hereby represent and warrant to the Company that: any oral or written alteration, modification or waiver of a. You and Your Sub-Producers are legally and properly any of the terms or conditions applicable to such qualified to act as insurance Producers for the sale of Insurance Products. You further agree that if You or any life and accident and health insurance for the Company Sub-Producer are convicted of a felony after the within the areas where You or Your Sub-Producers effective date of this Contract, You will notify the Company are soliciting business on behalf of the Company, You or in writing immediately after such conviction. Your Sub-Producers are properly appointed and licensed; and b. You shall comply with and shall cause Your Sub- 8.03 TAXES. Producers and employees to comply with all applicable You are to pay all occupational taxes and municipal taxes. All federal, state and local statutes, laws, regulations and rules, premium taxes will be paid by the Company. including, but not limited to, the USA PATRIOT Act of 2001, and the statutes administered by the U.S. Treasury 8.04 ADVERTISING MATERIALS. Department's Office of Foreign Assets Control ("OFAC") All advertising materials of any kind, including form letters and the Telephone Protection Act of 1991 as amended in (duplicated by any means as well as individually typewritten 2003, and the National Do Not Call List administered by the form letters), telephone listings, signs, or any other materials used Federal Trade Commission ("FTC") and will take such by You, including comparisons, which use or include the name, action as is necessary to amend this Contract from time to logos or trademarks of the Company, or which describe Insurance time as is necessary for the Company to comply with the Products produced by the Company, shall be submitted to the requirements of the USA PATRIOT Act of 2001, and the Company and shall not be printed, circulated or used without the statutes administered by the U.S. Treasury Department's Company's prior written approval. Office of Foreign Assets Control and the Telephone Protection Act of 1991 as amended in 2003, and the National 8.05 USE OF COMPANY STATIONERY. Do Not Call List administered by the Federal Trade Neither You nor Your Sub-Producers are authorized to make any Commission ("FTC") and You or any person acting on use whatsoever of the Company's stationery without the express Your behalf, are responsible for ensuring that any telephone written consent of an officer of the Company. or fax number(s) that You call or send documents to are screened against Do Not Call/Fax registries before the number is called for telemarketing purposes; and any other 8.06 BOOKS AND RECORDS. action as necessary to comply with any other applicable law; All sales materials, rate books, policy record cards, records, and printed matter and other supplies furnished by the Company are c. You have never suffered the loss, suspension or the property of the Company. You shall be responsible for their termination of any license issued by any governmental care and shall return them to the Company upon termination of authority in connection with the sale of any type this Contract. of insurance, and certify that You are in compliance as mandated by the Violent Crime Control and Law 8.07 BONDS. Enforcement Act of 1994 having not been convicted Bonds, as required by the Company or any insurance regulatory of a felony; and authority, shall be paid for by You. 9 8.08 RIGHT TO SET-OFF. Company, except that neither any indebtedness to the Company The Company may set-off any debts, due or owing at any time by under previous contracts or otherwise, nor Your rights to You or Your Sub-Producers to the Company, against any monies commissions, fees, or bonuses payable on account of applications payable by the Company under this or any previous Contract. procured by You, on which the policies were issued and paid for Any such set-off shall not constitute an election by the Company prior to the date hereof, shall be impaired except as agreed in to forego any other remedy to collect any indebtedness that You Section 8.01. might owe the Company. 8.15 ASSIGNMENT. 8.09 CONCLUSIVE ACCOUNTING. Neither this Contract nor any beneficial interest therein can be The Company will give to You a statement of all monies assigned, transferred or disposed of by You without the prior becoming due and payable to You since the date of the preceding written consent of the Company. The Company may assign this statement. Unless You file written objections to such statement Contract without Your consent to any corporate successor-in- or accounting within thirty (30) days after the date upon which interest, successor-in-merger, or successor-in-consolidation. the statement is mailed to You at Your notice address or made available to You electronically, the statement shall be deemed 8.16 NOTICES. conclusively correct and You shall waive any right to contest the Any notice required by the terms of this Contract shall be in amounts stated therein in the future. writing and will be deemed given when it is deposited in the United States mail, postage prepaid, properly addressed to You 8.10 GENERAL INDEMNIFICATION at Your last known business address, or to the Company at its home office in Oklahoma City, Oklahoma. OF THE COMPANY. You agree to reimburse and/or indemnify and hold the Company harmless from any loss, costs, liabilities, or damages which are 8.17 CHOICE OF LAW, PLACE incurred by the Company as a result of Your acts or omissions or OF PAYMENT AND the acts or omissions of Your employees, including the violation of any law or regulation; and without limiting the generality of ENFORCEABILITY. the foregoing, You further agree to reimburse the Company for All compensation payable hereunder shall be payable at any expenses which it may incur in enforcing Your obligations Oklahoma City, Oklahoma. In consideration of the execution hereunder, including but not limited to court costs and attorneys of this Contract and other valuable considerations, You agree fees. The terms "acts or omissions" as used in this paragraph that this Contract shall be governed as to its interpretation and include, but are not limited to, failure to comply with this construction by the laws of the State of Oklahoma without giving Contract's provisions; the Company underwriting guidelines, effect to any conflict of laws doctrine which may result in the procedures, directives, instructions or requests from the Company application of the laws of another jurisdiction and that venue for employees, or violation of any statute, law, rule or regulation or any legal proceeding brought under this Agreement by either failure to comply with any administrative or court order. of the parties hereto shall be restricted to the District Court of Oklahoma County, Oklahoma or the United States District Court for the Western District of Oklahoma, both located in Oklahoma 8.11 CONVENTION AND PRIZES. City, Oklahoma. It is expressly agreed that the Company will have the whole and exclusive right to designate which, if any, Producer will be invited to attend any Company convention or meetings and to 8.18 HEADINGS AND TITLES. receive any prize under the Company contests. The headings and titles used herein are for reference only. They are not to be construed to be a substantive part of this Contract or in any way to affect the validity, construction or effect of any 8.12 MODIFICATION OF CONTRACT. contract provisions. Except as provided herein, this Contract shall not be modified except in writing signed by You and the President, Vice President or Secretary of the Company. 8.19 ERRORS AND OMISSIONS COVERAGE. 8.13 NON-WAIVER. You agree to maintain in force, at Your own expense, while this The forbearance or neglect of the Company to require a strict Contract is in effect, errors and omissions insurance coverage compliance on Your part with any of the terms and conditions of acceptable to the Company. You further agree to provide Us with this Contract, or to declare a default for failure to perform when copies of the current declaration page evidencing the issuance of it shall become known to the Company, shall not operate as a the errors and omissions insurance as required hereunder at the waiver of any of these terms or conditions or as a release of You time of execution of this Contract, and within ten (10) business from Your obligation thereafter to perform this Contract strictly days of each date such insurance is discontinued, suspended, in accordance with its terms and conditions. reduced or terminated for any reason whatsoever. 8.14 SOLE AGREEMENT. 8.20 BINDING CONTRACT. This Contract is in lieu of all other agreements, understandings, This Contract shall be binding upon the heirs, administrators, or contracts heretofore or now existing between You and the 10 executors, successors and assigns of the parties hereto. 8.21 COMPANY PROPERTY. c. You will provide competent and customer focused sales Sales brochures, applications, rate books, software, policyholder and service based upon the customer's insurable needs or cards, and all other supplies furnished by the Company will financial objectives. Any information given to customers remain Company property and shall be accounted for and will be consistent with making buying decisions returned by You or Your Sub-Producers on demand. You agree appropriate for them; to be responsible for any damage or misuse thereof. Company property is subject to examination by a duly authorized d. You will engage in active and fair competition; representative of the Company at any time. e. You will only use advertising and sales materials that are clear as to purpose, honest and fair as to content, and have 8.22 BANKRUPTCY. been approved by the Company prior to Your presentation If You should take or be placed in bankruptcy to the extent of to a customer; any amount due the Company under this or any other Contract with the Company, no compensation shall be payable under this f. You will notify the Company immediately of all customer Contract and any such compensation shall immediately become complaints or disputes so the Company can handle them the Company's property. fairly and expeditiously; SECTION IX g. You will never make promises for the Company without expressed written authorization; MARKET CONDUCT AND ETHICS h. You will only accept signatures that You know to be authentic on documents for the Company; 9.01 The Company strives to adhere to high ethical and business i. You will fully comply with all laws and regulations principles. To promote these principles, the Company has regarding the marketing and sales of the Company's formally adopted as corporate policy the Code and Principles Insurance Products; of Ethical Market Conduct as promulgated and endorsed by the Insurance Marketplace Standards Association ("IMSA"). The j. You will agree to actively participate in periodic training Company has also adopted and implemented written statements and continuing education on compliance with laws and of policy based upon the IMSA Principles and Code. We ask all regulations relating to the marketing and sales of the of Our Producers and Sub-Producers to join Us in complying Company's Insurance Products and the concepts contained with and fully supporting these high ethical standards: within the IMSA Principles and IMSA Code; a. You will conduct Your business according to high standards of honesty and fairness and render that service k. You will agree to refrain from making disparaging to Our mutual customers which, in the same remarks about the Company's competitors. ("Disparaging circumstances, You would apply to and demand for remarks" do not include relevant, factually accurate Yourself; information); and b. You will use Your best efforts to notify the Company of l. You acknowledge and agree to comply with the IMSA any new designations or memberships in professional Principles of Ethical Market Conduct, the IMSA Code and organizations which have or support ethical market the AFA Statement of IMSA Policy adopted by the conduct standards; Company. BENEFICIARY DESIGNATIONS. (See Section VII, paragraph 7.06) Primary Beneficiary(ies): Name Address Relationship __________________________________________________________________________________________________ __________________________________________________________________________________________________ Contingent Beneficiary(ies): __________________________________________________________________________________________________ __________________________________________________________________________________________________ 11 AGENT ELECTRONIC SIGNATURE AUTHORIZATION The undersigned Agent of the Company hereby authorizes as follows: You authorize the Company or its authorized agent or representative to use Your signature in an electronic format and store such on a designated and secured computer system. You understand that Your electronic signature will never be used without Your prior consent. Your electronic signature will only be used when You submit prior authorization for each applicant. You understand that You may submit such authorization by either: 1) completing an American Fidelity Assurance Company EZ-Form application that contains information about an applicant for insurance and Your written authorization to attach Your electronic signature to the final insurance application for such applicant; or 2) providing an applicant with the Internet Address of the Secured AFAdvantage® Term Life web site along with the appropriate Agent ID/password. The undersigned Agent of the Company hereby acknowledges as follows: 1. You have received and reviewed the Company's memorandum dated October 1, 2003, concerning the national do not call registry. 2. The Company has a procedure to "screen" any telephone number it furnishes to You to ensure that such telephone number is not on the national do not call registry. 3. If You, or any person acting on Your behalf, make telemarketing calls to any telephone number that has been acquired from a source other than the Company, the Company will not be responsible for screening any such number to ensure that it is not on the national do not call registry, and state's do not call list or any "in-house" do not call list. You will be responsible for ensuring that any telephone number acquired from a source other than the Company is screened against the national do not call registry, any state's do not call list and any "in-house" do not call list before the number is called for telemarketing purposes and will assume all liabilities and indemnify and hold the Company harmless from all claims, suits and demands of every kind and nature, including any and all actions, causes of action, suites, judgments, controversies, losses, damages, costs, liens, charges, court costs, reasonable attorneys' fees, payments, liabilities and expenses whatsoever occasioned by, resulting from, arising out of, related to or in connection with Your failure to do so. DIRECT DEPOSIT FOR COMMISSIONS (Please include a void check or copy of a void check) Remember, commission checks are only generated if the payout amount is greater than $25.00. This will remain the same for direct deposits. Name of Bank:______________________________________ Account #:_______________________________________________ Routing #: _______________________________________________ Circle one: Checking Savings It is hereby understood and agreed that by completing the above information and signing below, I authorize American Fidelity Assurance Company to deposit my commissions into the above named account. This Contract authorizes Us to print Your name in Company publications unless You notify Us in writing. You understand and agree to the terms of this Contract executed this _________ day of _____________________, ______________. By: __________________________________________________ PRODUCER (You) By: __________________________________________________ AMERICAN FIDELITY ASSURANCE COMPANY ("Company") Authorized Signature M-2393 AFAL (Producer) (R0405) 12 ANTI-MONEY LAUNDERING TRAINING CERTIFICATION Have you had any anti-money laundering training in the last 12 months? Yes. I hereby certify that within the last 12 months, I have taken an anti-money laundering training course from an insurance company, approved for continuing education by the insurance regulator in my state of domicile or, sufficient to count toward my continuing education requirements under NASD Rules. • Please provide a copy of your Certificate of Completion Yes. I hereby certify that within the last 12 months, I have taken an anti-money laundering training course. • Please attach a copy of the certification of completion No. I have not taken any anti-money laundering training in the last 12 months. (If you check that training has not been taken, your appointment will be declined.) Print Name __________________________________ Signature____________________________________ Date __________________ AGT CERT FORM 06/07
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Originally written on Fox Sports Florida | Last updated 2/6/13
MIAMI (AP) -- LeBron James scored 32 points, Dwyane Wade added 31 points and eight assists, and the Miami Heat held off the Houston Rockets 114-108 on Wednesday night. Shane Battier scored 12, Norris Cole added 10 and Udonis Haslem grabbed 13 rebounds for Miami, which moved to 20-3 at home. James Harden finished with 36 points and 12 rebounds for Houston, which got a 15-point, 14-rebound night from Omer Asik and 15 more points from Patrick Patterson. Jeremy Lin and Chandler Parsons each scored 13 for the Rockets. A night after tying an NBA record by connecting on 23 3-pointers, the Rockets finished 9 for 25 from beyond the arc. Miami played without Chris Bosh, who missed the game with the flu. Heat coach Erik Spoelstra said he hoped Bosh would be well enough to play Friday when Miami hosts the Los Angeles Clippers. The game had a distinct trend: Miami would try to take control, Houston would claw back. And it held true all the way to the end. Even with Miami up 12 with 6 minut...
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subset: commoncrawl


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They feel bad, so they found you these other deals to make up for it.
Select Local Merchants
Reflections BingoRead MoreReflections Bingo, named Best Bingo joint in both 2008 and 2009 by the Phoenix New Times, has drawn flocks of players for more than 20 years to compete in cash-prize games that ultimately benefit local arts and entertainment causes. A real human rather than an electronic machine calls out numbers so players don't have to translate robotic bleeps and bloops. Reflections Bingo features a different game every evening, such as the $9 special session, which features a $1,000 jackpot every night. A portion of game proceeds go toward local charities such as the Young Sounds of Arizona, Phoenix Federation of Musicians, and the Phoenix Chorale.3415 West Northern AvenuePhoenix, AZ US
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SANDRA 2005 Lite memory bandwidth
With a normal 33 processes running, system in sig, I get a 6893 / 6814 in SANDRA 2005 Lite for memory bandwidth. Is this good? What are you guys getting with your o/cd setups? Mine is at DDR500 btw.
Just changed timings to 2.5-3-3-11-1 and got 6927 / 6870.
Re: SANDRA 2005 Lite memory bandwidth
Yes, it's good. I get 6100 MB/s.
Try unbuffered test. I get 4700 MB/s
Re: SANDRA 2005 Lite memory bandwidth
Hmm :D I got like 3580/3530 mb/s... but I have 333mhz memory running at 320Mhz so that could explain it, couldn't it?
I have to say WOW when I look at your setup; you've clocked your 2.4ghz to 3.4ghz? that's kinda insane... I can't even reach 3ghz and I have watercooling :-S maybe you'll let me in on your oc'ing secret?? ;)
thnx in advance
Re: SANDRA 2005 Lite memory bandwidth
Thanks ;) Could you send me that vidcard of yours :)
Get a 2.4C from malaysia. And a P4C800. My P4P800 is good, but it won't allow for 1:1 over FSB 250MHz, though my whole setup can do 283MHz (ram and CPU). So I'm at 4:5. And the worst part is, I actually was able to enable PAT up to FSB250!!! But my northbridge is f* up, all P4P800 seem to be, and it shoots out all sort of errors over 250MHz at 1:1
With that 6800 and Northwood C, your PSU might also be limiting you.
No overvolting. Air cooling. Is there no way you can coax a 4:5 ratio from that memory of yours? To go over 333MHz, maybe you could slack mem latencies?
Re: SANDRA 2005 Lite memory bandwidth
Okey thnx.. :) but my mobo doesn't even allow me to change cpu ratio :( which kinda sucks... but I can change the speed of my RAM though and doing that helps me to up the FSB :) so my memory is running only at 266mhz, but I've upped my fsb so that it's running at 320mhz(can't do 330mhz for some reason which would allow me to have 3ghz) :(... and I don't think it's my PSU since it says that my ram timings are set too "something" :) and not allowing me to reboot :-/... but maybe I'll get a 3.2Ghz p4 and 1Gb of ddr 400 :) that would probably allow me to oc higher :D
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