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LICENSING AND APPOINTMENTS
Licensingand Appointment Documents A3072-01 Thispacketcontains: . FinalExpense LifeInsurance SellingAgreement- FormA3073-01 . Forethought'University - FormA3075-01 Certification . Schedule for FinalExpense of Commission LifeInsurance Sales- FormM2112
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I S S U EB DYF O R E T H O U GLH I FTEI N s U R A N C CEO M P A N YT
FroUGHT' o 2008 Forethought 0 10 8
ForethoughtLife InsuranceGompany/Forethought NationalLife InsuranceCompany
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FINALEXPENSELIFE INSURANCE SEttING AGREEMENT
This Agreementis entered into by and between ForethoughtLife InsuranceCompany,a corporationorganizedunder the laws of the State of Indiana,or ForethoughtNationalLife InsuranceCompany,a corporation organizedunderthe lawsof the Stateof Texasfor all sales transactedin Texas, having its principaloffice at One Forethought Center, Batesville, Indiana 47006 (hereinafter referred to as "Company,""us," "we," or "our."),and the Agency/Agentidentifiedin the AppointmentData and Informationsection of this Agreement (hereinafterreferredto as "Agent","you" or "your"). This Agreement shallbe effectiveupon its acceptanceby Companyat its administrative officeslocatedin Batesville,Indiana. lt is agreed by the partiesas follows: APPOINTMENTS, AGENTSAND INDEPENDENT CONTRACTOR STATUS APPOINTMENT.Companyappointsyou as one of its Agentsfor the purposeof procuring,throughagentsappointedby us or assignedto you by us, applications for individualand group life insurancepolicies (hereinafter referredto as "policy"or "policies") whichwill be issuedby Company. For the purposesof this Agreement,the term "application" shall include enrollmentof personsfor individualor group policies. Unless previouslyapprovedby us in writing,you and your agents appointedby us may not beginsolicitation of policiesuntilsuchtime as we haveissueda letterconfirmingthe appointment(s). INDEPENDENT CONTRACTOR, TAXES AND OTHER OBLIGATIONS. You are an independentcontractorand nothing contained in this Agreement shall be construed to create the relationshipof employerand employeebetweenyou, or any other judgmentas agent,and us. You shall be free to exerciseindependent to the personsfrom whom applications for policieswill be solicitedand the time and place of such solicitations.You shall make and file all reports and returns required by any federal or state statute or regulationpertainingto withholdingtaxes, unemploymentinsurance, pensionand profitsharingplans,and shallpay all taxes,contributions, interest,or penaltiesthereunderin connectionwiththe wages,salaries, or other remunerationpaid or allowed by you to employeesor appointeesof yours or to others. You assumefull responsibility and exclusiveliabilityfor failureto complywithany suchapplicablestatutes or regulations. As an independentcontractorand not an employeeof ours,all agency expenses,includingbut not limitedto rentals,transportation, salaries, attorney or legal fees which pertain to the administrationof your business, postage, advertising,agent licensingfees and/or agent occupational taxes,shallbe yourliability and notours. APPOINTMENTOF AGENTS. Your subordinateagents(hereinafter referredto as "agent"or "agents")include:(a) agentsassignedto you by us and (b) agentsappointedby you and subjectto the termsof this Agreement,providedyou maintain(to the extentrequiredby applicable statelaw)a validlicenseand appointment as our agentin eachstatein which you appointany such agents. Each agent whom you appoint must be validly licensedand executea written agent's agreement directlywith us, and such agreementshallbe effectiveonly when also executedby us. You haveno authorityto modifyor amendany part of such agreement. We reservethe followingrights at our discretion without liabilityto you: (a) to refuse to contractwith any proposed agent and (b) to terminateour agreementwith any of your agents underthe termsof suchagreement. NONEXCLUSIVETERRITORY. You are authorizedto do business underthe conditionsof this Agreementin any state in which we are authorizedto do businessand to issuethe specificpolicyyou intendto sell providedyou are properlylicensedin suchstateto sell suchpolicy. No territoryis exclusivelyassigned.We reservethe rightto withdraw A3073-01
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from all or any portionof any state(s)at our discretionwithoutliability to you. RESPONSIBILITIES OF AGENCY/AGENT.You shall be resDonsible for the fidelityand honestyof all of your agents. All moniescollected, received,or which otherwisecome into your controlor the controlof your agents, which belong to us, our policy or certificateowners (hereinafterreferredto as a "policyowner"or as "policyowners")or applicantsshall be securelyheld in a fiduciarycapacityand shall not be used for any personalor other purposeswhatsoever,but shall be immediatelypaid over to us. You guaranteethe paymentto us of all monies intendedfor or owing to us, our policy owners,prospective policyowners,or applicantsthat are collected,received,or otherwise comeintoyourcontrolor the controlof your agents. RESTRICTED AUTHORITYOF AGENCY/AGENT.Your right,power, or authorityon our behalfshall exist only as expresslystated in this Agreement. No right,power,or authorityshall be impliedeitherfrom the grant or denial of powers specificallymentionedherein or the failureto mentionany right or power herein. You agreethat you and your agentsare withoutauthorityto do or performand expresslyagree not to do or performthe followingacts on our behalf: (a) incur any indebtednessor liability;(b) make, alter, or dischargecontracts;(c) waive forfeitures;(d) quote rates other than as quoted by us; (e) extendthe time for paymentof any premium;(f) waive paymentin cash; (g) guaranteedividends;or (h) deliverany policymore than ten days after issuanceby us or fail to promptlyreturnthe deliveryreceipt to us. Further,you agreethat you and your agentsshallnot: (i) violate the insurancelaws of any state in which you may be soliciting applicationsfor policies;fi) withholdany of our, the policy owner's, prospective policyowner'sor applicant'smoniesor property;(k) rebate or offer to rebateall or any part of a premiumon our policies; (l) induceor attemptto induceany of our policyownersto discontinue paymentof premiumsor to relinquishany policy;(m) induceor attempt to induceany of our agentsto leave our service;(n) perpetrateany fraud against us, or policy owners, prospectivepolicy owners or applicants;(o) fail to providecontractdisclosuredocumentsto policy applicantsas requiredby the Companyor applicablestatelaw; (p) fail to providecompensation disclosureto policyapplicantsas requiredby statelaw;or (q) violateany Policiesand Proceduresof the Company. COMMISSIONS AND CHARGEBACKS COMMISSIONS. You shallbe paidcommissions on premiumspaidto and receivedby us, in accordancewith the Scheduleof Commissions attachedheretoand made a part hereof.We reservethe right,in our sole discretion,to amend the Scheduleof Commissionsat any time; provided,however,that any such change shall only be effectivefor commissionspayableon applicationsdatedafter the effectivedate of suchchange.Commissions shallbe paidhereunder onlyfor so longas you or your agentare the agentof record.Commissions are subjectto chargebackin accordancewith the Scheduleof Commissions.Your commissionsshall be reducedby the amountof any commissionsto which your agents are entitledand we pay directlyto such agents. Commissionsshallbe payablehereunderonly in accordancewith the Scheduleof Commissionsand shall not be allowed on premiums waived or commutedby reason of death, disability,or exerciseof policyoptions. Commissionsthat become payableshall be paid to you, your executors,administrators, or assigns;however,neitherthis Agreementnor any benefitsto accruehereundermay be assignedor transferred,eitherin wholeor in part,withoutour writtenconsent. In no eventwill you be entitledto receivecommissionsthat revertto you from your terminatedagentsin excessof the amountsuch terminated agents would have received under the provisionsof their agent agreementswith us; providedhowever,that this shall not impairany right you may have to receiveoverridecommissionson any policies @2008 Forethought 0 10 B
writtenby the terminatedagentwhich remainin forceafterthe date of suchagent'stermination. SET-OFFSAND CHARGEBACKS AGAINSTCOMMISSIONSYou due or to agreethat we may, at any time, set-offagainstcommissions becomedue to you, or to anyoneclaimingthroughor underyou, any amountdue from you or your agentsto us includingany chargebacks. lf not set-off,all such amountsshall be paid to us within 30 days of writtenrequesttherefor.We do not waive any of our rightsto pursue collectionof any indebtedness owed by you or youragentsto us. In the eventwe initiatelegalactionto collectany indebtedness of you or your agents, you shall reimburseus for reasonableattorney'sfees and expensesin connectiontherewith. This provisionshall remainin full forceand effectregardlessof any termination of this Agreement. STATEMENTOF ACCOUNT. We will furnishyou a copy of your commissionaccountweekly providedthat transaclionsoccur in your account during the previousweek. Unless you notify us in writing within30 days of the issue date of each statementof any differences betweensuch statementand your account,you shallhave waivedthe rightto contestthe accuracy,correctness, and basisof the statement. Such statementshall be comoetentand conclusiveevidenceof the statusof your account. ADVERTISING ANOADMINISTRATION REPRESENTATION.You and your agentswill nol representyourself that impliesexperlise as holdingany professional or lrade certification in financial matters relating specificallyto persons 65 or older, includingbut not limitedto "certifiedsenioradvisor,"until and unless you provideus with completeinformationregardingthe natureof such certificationand we approvein writingthe use of such certification in connectionwiththe saleof our product. RESERVATIONS.We reservethe followingrightsat our discretion withoutliabilityto you: (a) to changecommissionson any policyform or riderupon furnishingnoticeto you, but such changeshallnot affect applicationsreceivedby us prior to such notice,(b) lo withdrawany policy forms; (c) to change our premiumrates, (d) lo reject policy applicationsor premiumswithoutspecifyingcause,and (e) to adopt policiesand proceduresfrom time to time relatingto any matter nol otherwisecoveredin this Agreement. ADVERTISING.You and your agentsshall not use or authorizeany advertisement, circular,news releaseor other communicationusing our nameor our productnames(whetherwritten,oral,audio,or visual) withoutpriorwrittenapprovalby us. and policy PERSONALPROPERW AND FUNDS. All application forms,relatedadvertisingand marketingmaterials,books,documents, vouchers,receipts,lists,notices,or other papersof any kind used by you in any transactioninvolvingus and any other personalproperty furnishedby us shall remainour property,shallbe open to inspection by us at all times, and shall be returnedto us at terminationof this Agreement along with all uncollected premium receipts and policiessentto you for deliveryand collection. undelivered REIMBURSEMENT.You agreeto pay directlyor reimburseus for the followingexpenses: (a) all agent taxes, municipallicensefees, and localand statetaxesfor the territorycoveredby this Agreement,(b) all and (c) the premium chargesprovidedin our policiesand procedures, for an indemnitybond in a satisfactoryamountto secureyour fidelity and faithful performanceunder this Agreement,if such bond is requestedby us. MISCELLANEOUS or legal LEGAL ACTION. You may not instituteany administrative proceedingson our behalf without our written approval. lf any administrativeor legal action is broughtagainstyou or us, or both jointly, by reason of any alleged act, fault, or failure by you in connectionwith your activitieshereunder,we may require you to or defendsuch actionat your expense. lf we bringany administrative legalaction,or both,by reasonof an allegedact,fault,or failureby you A3073-01
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in connectionwithyouractivitieshereunder,we may requireyou to pay for an attorneywho we selectto representus. However,at our option, we may defendor instituteany such actionand expend such sums, includingattorneyfees,as may in our judgmentbe necessary,and you will be requiredto reimburseus for all suchamounts. INDEMNIFICATION.You hereby agree to, at all times hereafter, defend,indemnifyand hold harmlessthe Company,its affiliatesand their respectiveemployees,officers,directorsand shareholdersfrom all claims, liabilityor loss which result from your real or alleged negligentor willfulacts, or your errors,omissionsor breach of any provisionof this Agreementand such acts, errors, omissions or breachesof your servants,agentsor employees,in the performanceof dutiesunderthis Agreement.Claims,liabilityor loss includes,but is not limitedto, all costs,expenses,attorneyfees and other legal fees, penalties,fines, direct or consequentialdamages, assessments, punitivedamagesto the extentpermissible verdicts(including under the law of the state where any claim or suit is filed which seeks recoveryof punitivedamagesagainstus) and any other expenseor expenditureincurredby us as a result of your performance,or the performance of your agent(s),underthe termsof this Agreement.This indemnification will be in additionto any liabilityyou may otherwise have. We herebyagreeto, at all timeshereafter,defend,indemnifyand hold you and youremployees,officers,directorsand shareholders harmless from all claims,liabilityor loss which result from our real or alleged negligentor willfulacls, or our errors,omissionsor breachof any provisionof this Agreemenl,and such acts, errors, omissionsor breachesof our servants,agentsor employees,in the performanceof dutiesunderthisAgreement.Claims,liabilityor loss includesall costs, expenses,attorneyfees and other legalfees,penalties,fines,director consequentialdamages, assessments,verdicts (including punitive damagesto the extenl permissibleunderthe law of the state where any claim or suit is filed which seeks recoveryof punitivedamages againstyou) and any olherexpenseor expenditureincurredby you as a resultof our performanceunderthe terms of this Agreement. We agree to provideyou with policiesthat to the best of our knowledge minimuminsurance and beliefmeetall applicable codeand regulatory compliance requirements. TERMINATION. This Agreementmay be terminatedwithoutcause by eitherpartyuponat least 15 days priorwrittennotice,or immediately, upon writtennotice,for cause. This Agreementshall terminatefor cause in the eventof your breachof any provisionof this Agreement. Such terminationshallnot impairyour rightto receivecommissionson policiespreviouslyprocuredexcept if terminationis becauseof your breachof any provisionof this Agreementin whichcase commissions will not be paid after date of termination.Commissionspayable hereunderafterthe termination of this Agreementshallbe paid only so long as such commissionsexceed $300 during any calendaryear. Afterterminationof this Agreement,all amountsowed to us hereunder are due and payableimmediately withoutfurthernoticeor demand. COMPLAINTSAND INVESTIGATIONS. You shallcooperatefully in any insuranceregulaloryinvestigation or proceedingor judicial proceedings withthe policiesmarketedunderthis arisingin connection Agreement.Withoutlimitingthe foregoing: (a) You will promptlynotifythe Companyof any written customercomplaintor noticeof any regulatoryinvestigation or proceeding or judicialproceedingreceivedby you or your withany policymarketedunderthis agentin connection Agreementor any activityin connectionwith any such policy. (b) In the caseof a customercomplaint,you will cooperatein investigating suchcomplaintand any responseby you to suchcomplaintwill be sentto the Companyfor approvalnot lessthanfive businessdayspriorto its beingsentto the authority,exceptthat if a more customeror regulatory promptresponseis required,the proposedresponseshallbe communicated by telephoneor facsimile. (c) The provisions of this sectionshallremainin full forceand effectregardlessof any termination of thisAgreement. O 2008 Forethought 0 10 8
as CUSTOMERINFORMATION.You shalltreatcustomerinformation confidentialas requiredby applicablelaw and by the Company,as describedin the Company'sprivacynoticesand in accordancewiththe Companypoliciesand procedures. You shall also take reasonable and appropriatesteps to establish and implementadministrative, physical and technical proceduresto ensure the confidentiality, security and integrityof customer informationin accordancewith applicablelaw. You agreeto complywith the Company'stermsof use, policiesand procedureswith respectto use of Companyelectronic systemsand databasesprovidingaccessto customerinformationby you, your employees,and agents and shall promptlyreport to the Company any breach of security related to such systems and databasesof which you becomesaware. You may use customer informationonly for the purposeof fulfillingyour obligationsunderthis Agreement. You will limil access to customerinformationlo your employees,agentsand otherpartieswho needto knowsuchcustomer information to permit you to fulfill your obligations under this in Agreementand who haveagreedto treatsuchcustomerinformation accordancewiththe termsof this Agreement.You shallnot discloseor to anyoneotherthan otherwisemake accessiblecustomerinformation relates(or to his or her legally to the individualto whomthe information or to other persons pursuantto a valid authorizedrepresentative) signedby the individualto whom the informationrelates authorization (or by his or her legallyauthorizedrepresentalive), exceptas required for you to fulfillyour obligationsunder this Agreement,as otherwise directedby the Company,or as expresslyrequiredby applicablelaw. For purposes of this Agreement, "customer information"means informationin electronic,paper or any other form that you or your agents obtained,had access to or createdin connectionwith your individuals who appliedfor regarding obligations underthisAgreement or purchased policies. Customer informationincludes nonpublic personalinformation,and protectedhealthinformation,as definedin applicablelaw. Customerinformationmay also include,bul is not limited to, informationsuch as the individual'sname, address, telephonenumber,socialsecuritynumber,as well as the fact that the a policy individual has appliedfor, is insuredunder,or has purchased issued by the Company. Customerinformationdoes not, however, that is ('1)generally availablein the publicdomain includeinformation and is derived or receivedfrom such public sources by you; (2) from received,obtained,developedor createdby you independently the performanceof your obligationsunder this Agreement; (3) disclosedto you by a third party,providedsuch disclosurewas made to you without any violation of any independentobligation of or applicablelaw of whichyou are aware. confidentiality
for any amendmentof the Scheduleof Commissionspursuantto the terms of this Agreement,may not be modifiedin any way unless by writtenagreementsignedby the partiesto thisAgreement. All agreementsbetweenyou and us are containedin this Agreement, includingthe followingexhibitwhich is attachedheretoand made a oarthereof: Scheduleof Commissions. In the event that any provisionor clause of this Agreement is in any respect,the determinedto be invalid,illegal,or unenforceable validity, legality and enforceabilityof the remaining provisions containedhereinshallnot in any way be affectedor impairedthereby. ASSIGNMENTS;RIGHTS AND REMEOIESARE CUMULATIVE. Neitherpartyto this Agreementmay assignits rightsor duties under this Agreementwithoutthe prior wrilten consentof the other parly. The rights,remediesand obligationscontainedin this Agreementare cumulative and are in additionto any and all rights,remediesand at law or in equity,whichthe partiesheretoare entitledto obligations, understateand federallaws. NOTICES. Any noticesrequiredunder the terms of this Agreement shallbe sent,if to the Agentat the addressset forthin the Appointment Dataand Information sectionof saidAgreement,and if to Companyat: Forethought Financial Services Inc., One Forethought Center, Batesville,Indiana47006,or at such other addressesas either party may fromtimeto time designateto the otherin writing. CONTACTINFORMATION. Forethought LifeInsuranceCompanyor Forethought NationalLifeInsuranceCompany and Licensing c/o AgentContracting P . O .B o x2 1 6 Indiana47006-0216 Batesville, Phone: 888-606-6372 Fax: 800-675-7542
For purposesof this Agreement,"applicablelaw" meansany state or federal law, rule or regulationsincluding,but not limited to, state Act and and the Gramm-Leach-Bliley insurancelaw and regulations relatedfederalregulations. ANTI-MONEYLAUNOERINGPROGRAM. You agree that you will remain in compliancewith all applicableanti-moneylaunderinglaws and regulations.You furtheragree to fully cooperateand assistthe and carryingout its anti-moneylaundering Companyin implementing programas applicableto youractivitiesunderthisAgreementincluding providing requested customer information, following customer procedures,and cooperating with the requiredtrainingof identification agentsand employeesincludingprovidingany requestedcertification regardingsuchtraining. and information or ENTIREAGREEMENTAND CHOICEOF LAWS. Forbearance negligenceby us to insist upon complianceby you with any of the terms and provisionsin this Agreementshall not be construedas or constitutea waiver thereof. This Agreementshall be interpretedin accordancewith, and governedby, the laws of the State of Indiana.. Unlessotherwiseprovided,all mattersto be performedby us under this Agreementshallbe performable al our officein Batesville,Indiana. shallbe payable Any amountdue to eitherpartyunderthisAgreement at our office in Batesville,Indiana. Any suit arising under this Agreementbetweenyou and us shall be institutedand tried in Ripley County,Indiana. This Agreementsupersedesall prioragreements, eitheroral or written, betweenthe partiesrelatingto the subjectmatterhereof,and except A3073-01
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IMOCompleteSolutions Inc055901 JT APPOINTMENT DATAAND INFORMATION
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PREFERENCES COMMUNICATION Preferred method of communication (Choose One)
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AGENTSTATEMENTS(lf vou answer Yes to
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Have you ever plead no contest or been convicted of a crime, including felony, misdemeanor or military offense? Yes fl No D
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Have you ever had a license refused/suspended/revokedor currently restricted or under investigation? Yes! Notr
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Has an insurance carrier cancelled your contract or appointmenl for any reason other than lack of productivity? YesD NoD
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Do you have any knowledge of an indebtedness to an insurance carrier or financial organization that involves yourself or an organization you h a v e b e e n a s s o c i a t e dw i t h , o r d o y o u h a v e a n y u n s a t i s f i e dl i e n s o r j u d g m e n t s ? YesE NoU
ACT DISCLOSURE TO PROSPECTIVE FAIRCREDITREPORTING AGENTS In compliancewiththe FairCreditReportingAct (FCRA)you are herebynotifiedthatthe Companymay obtaina consumerreport,or investigative as lo your creditworthiness,creditstanding,creditcapacity,character,generalreputation,personal consumerreport,includinginformation characteristics, modeof living,criminalrecords,and employmenthistory.Suchinquirywill be madeuponour receiptof your compleledAgreement. youauthorize By signingthisAgreement, us to maketheseinquiries. You havethe rightto obtaina completeand accuratedisclosureof the natureand scopeof the invesligation requestedand a summaryof your rights time afterour receiptof this document,suchadditionaldisclosureshallbe madeto underthe FCRA. Uponwrittenrequestto us withina reasonable you in writing. Pleaseforwardyour requestto. Forethought Life lnsuranceCompanyor Forethought NationalLife InsuranceCompany(foragentsseekingappointments in Texas) Attention:AgentContracting and Licensing P . O .B o x2 1 6 Batesville, lN 47006-0216 Or Fax To: 800-675-7542 For additionalinformation concerningthe FCRA,you can findthe completetextof the FCRA,15 U.S.C.1681et seq,at the FederalTrade Commission's web site (http:www.ftc.gov.)
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IMOCompleteSolutions Inc055901 AUTHORIZATION FORAUTOMATICDIRECTDEPOSIT(ACHCREDITS I herebyauthorize E Forethought Life InsuranceCompanyor E Forethought NationalLife InsuranceCompanyto initiateautomaticcreditentries, and the financialinstitution namedbelowto creditthe sameto suchaccount.I acknowledge that the origination to my account of ACH transactions mustcomplywiththe provisionsof U.S.law. This authorityis to remainin fullforceand effectuntilthe insurancecompanydesignatedabovehas receivedwrittennotification from me of its termination, allowingsaidcompanyenoughtimeto act on it. AccountName(print):
AccountType. D CheckingAccount E SavingsAccounl
PLEASEATTACHYOURVOIDEDCHECKOR SAVINGSDEPOSITSLIPHERE (BANK)TNFORMATTON oR coMPLETETHE FtNANCTAL TNST|TUT|ON BELOW: BankTelephone:(_)
Bank Name: Bank Address
City,State,Zip: AccountNumber:
BankTransiU RoutinoNumber:
ACKNOWLEDGEMENTS AND SIGNATU RE WRITINGAGENTCERTIFICATION ACKNOWLEDGEMENT I certify that I have read and understand Forethought'sAnti-Money Laundering Guidelines for Agents and Brokers and t h a t I w i l l f o l l o wt h e G u i d e l i n e s .I u n d e r s t a n dt h a t m y f a i l u r et o f o l l o wt h e G u i d e l i n e sc o u l d r e s u l t i n t h e i m m e d i a t e termination of my appointment to sell policies on behalf of Forethought Life Insurance Company or Forethought National L i f e l n s u r a n c eC o m p a n y . lnitials
TAXPAYERACKNOWLEDGEMENTS Under penaltiesof perjury,I certify that: 1. The numbershownon this form is my correctTaxpayerldentification Number;and, 2. I am not subjectto backupwithholdingeitherbecause:(a) | am exemptfrom backupwithholding;(b) | have not been notifiedby the Internal RevenueService(lRS) that I am subjectto backupwithholdingas a resultof a failureto reportall interestor dividends;or (c) the IRS has notifiedme that I am no longersubjectto backupwithholding. 3.
I am a U.S.citizen(including resident alien).
CertificationInstructions- You mustcrossout item2 aboveif you havebeennotifiedby the IRSthat you are currentlysubjectto backup withholdingyou havefailedto reportall interestand dividendson yourtax return.
I herebycertifythat my answersto the questionscontainedin thisAgreementare trueand correct.I acknowledge thatthe Companyhas informed me of its practiceto conductroutineinvestigative reportson me and my agentsfor licensingpurposes,initialand renewalstateappointments, and at any time Company,at its discretion, investigations. deemsit necessaryto conductbackground I expresslyauthorizeCompanyto conductthese investigations and authorizeall personsand entities(includingpastand presentemployers)to provideCompanyall requestedinformation.I hereby releasefrom liabilityall personsand entitieswhichsupplysaidinformation to Companyand agreeto holdCompanyharmlessfrom any liabilityfor conductingthis investigation.I herebyauthorizeCompanyto use theseinvestigative reportsand to providethesereportsand any otherpertinent information to any affiliatedcompaniesand to thirdpartieswherethe thirdparties'legalinterestsand/orobligations are involved.I alsoauthorize Companyto distributeany financial,business,legal,tax or work performance historyregardingme that it receivesfromthirdparties,from any affiliatedcompaniesor whichis generatedby Companyor fromany affiliatedcompanies'datasourcethat is not partof the investigative report,to all affiliatedcompaniesor to thirdpartiesincludingbul not limitedto agentsor agenciesthat assumeyourdebitbalanceresponsibilities. providedin saidAgreementis foundlo be incorrect I furthercertifythat I havereviewedthis Agreementand furtherunderstand that if any information or incomplete, it will be groundsfor rejectingthisAgreementor for termination of saidAgreement,all at the solediscretionof Company.I alsocertify thatthis Agreementhas not beenaltered,modifiedor changedby me in any mannerand that I agreeto be boundby the provisionsof said Agreement.
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IMOCompleteSolutions Inc055901 SIGNATURE lN WITNESSWHEREOF,Agency/Agenthas caused this Agreementto be executedeither individuallyor by its duly authorized representativesas of the date set forth below. E ForethoughtLife InsuranceCompany 0 ForethoughtNationalLife InsuranceCompany
AGENCY/AGENT
Print Name / Title
Date
AGENTCHECKLIST- Submit RequiredDocumentsto Your Checklist: ! D D D
Retaina Copy For Your
(43073-0'1 FullyCompleted SellingAgreement and SignedFinalExpenseLifeInsurance ) Copyof License/sfor ALL StatesWhereAppointmentis Requested VoidedCheckAttachedif Section#5 is NotCompleted SignedCommission Schedule(M2112)
tr CompleteHierarchy Information Sheet(43074-01) NationalLifeInsurance tr SubmitAll RequiredDocuments to Forethought LifeInsurance Companyat Fax Companyor Forethought or AddressBelow. MarketingOrganizationSignature:
Date:
Fax All Paqes of AqreementTo: Forethought LifeInsurance Companyor Forethought NationalLifeInsurance Company c/oAgentContracting and Licensing 800-675-7542
Mail All Paqesof AgreementTo: Forethought LifeInsurance Companyor Forethought NationalLifeInsurance Company c/oAgentContracting and Licensing P.O.Box 216 Batesville, lN 47006-0216
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Forethought@University Certification For Forethought@ForelifesM Representatives Partnering With Member Funeral Homes Section L t@Uni Certification am The educators of Forethought Life Insurance Company want to ensure you have the information you need to get off to a great start and continue to succeedwith us. This program will show the industry and your clients your expertise and commitment to Forethought's values of personal principles, standards and professionalism. Section 2 - R
irements for Certification
When you sign up to sell the Forethought@ ForelifesM product, follow this simple process: 1. Review the Code of ProfessionalResponsibility. 2. Sign this certification. This confirms that you have read, understood, and will comply with Forethought's Code of Professional Responsibility. 3. Remain in good standing with Forethought. Section 3 - Code of Professional ibili PnorrssroLiar Rrspo NStBtLrwro CorusuurRs 1 . Discuss coverage benefits with every consumer including funeral expensesand other end-of-life expensesand the unique rapid claims process. Forethought Life Insurance Company provides an easy process to set aside funds to pay for funeral and other end-of-life expenses. This unique plan includes a rapid claims process,providing your families with much needed funds at an extremely difficult time.
2. Introduce the complete Forethought@ForelifesM value offering including the ForeHelpsu Family Representatives and the planning tools available via the web. Explain to your clients that Forethought also provides end of life educatiory assistance,and planning tools through the ForeHelptt Family Representative and on the forethought.com website.
3 . Connect the consumer to a member of the Forethought Funeral Planning NetworksM for completion of the end-of-life planning process. Direct your client to work with a Forethought Funeral Planning NetworksM partner to select actual goods and services before or at the time of need. You or your client can find a funeral home professional in the area by using the forethought.com website, or by contacting the ForeHelpsu line at 1-800-959-5885.
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4. Remain ethical in all aspectsof business so as to serve each client in a professional and caring manner. Operate your business with the highest principles of honesty, integrity, and professionalism. PnorrssroNAl REspoN stBtLrrv ro F oRETHoUcHTFTINERAL PraLrrinric NrrwonxsM 1. Clearly represent yourself as a Forethought Forelife Representative and a partner to the Forethought Funeral Planning NetworksM so the consumer is able to distinguish your offerings from the funeral homes offerings.
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Phrasesthat contain the word "guarantee" MUST BE avoided when discussing the funeral arrangement process. For example, "Your funeral plan will be guaranteed if you take it to a funeral home." Orly a licensed funeral director can arrange and/or guarantee the details and handle the logistics of a funeral. 2. Promote the Forethought Funeral Planning NetworksM, Discuss accessto the largest end-oflife assistancenetwork in the United States with each client. Our trusted network of more than 5,000funeral homes and cemeteries are committed to helping families at their time of need and can assistthem in selectingfuneral merchandise and services prior to the time of need. PRorrssrorual REspoNstBtLtry ro F oRETHoUGI{TLIFEIrusunarucr CotupeNy 1,. Comply with AML Laws and Regulations, Agents must remain in compliance with all applicable anti-money laundering laws and regulations. Agents must fully cooperate and assist the Company in implementing and carrying out its anti-money laundering program as applicable to your activities including providing requested customer informatiory following customer identification procedures, and cooperating with the required training including providing any requested certification and information regarding such training. I CERTIFYthat I luae read,understandand will follow Forethought'sCodeof Professional Responsibility I understandthat for ForethoughtForeLifeRepresentatiaes. my failure tofollow the Codeof Professional Responsibilitymay result in the termination of my appointmentwith ForethouglttLife InsuranceCompany.
Forethought Forelife Representative Signature
Printed Name
Date A3075-01
@ 2008 Forethought
FORETHOUGHT@ FORELIFE" S C H E D U LO E FCOMMISSIONS A G E N TS C H E D U L E The Schedule of Commissions ("Schedule")is an addendum to Final Expense lnsurance Selling Agreement ("Agreement"). This Schedule is for Forethought Life Insurance Company and Forethought National Life Insurance Company ("Company")insurance policies sold under the attached Agreement which are issued on or after the Schedule Effectiv.eDate. No commissionswill be earned or paid unless the correspondingform of insurance policy is available for sale by Company in the applicablestate.
ScheduleEffectiveDate: Seotember 15.2008
CommissionAdvancePeriod: 9 Months
ForeLifesM Ten Pay
Life Pay
Year 1 lssue Ages 0-70 7 1- 7 5 76-80
Full Death Benefit
90.0% 90.0% 90.0%
Graded Death Benefit
90.0% 90.0%
Years2 - 10 Full Death Benefit
Graded Death Benefit
4.O%
2.0% 2.0%
4.0% 4.O%
Years2 - 10
Year 1 Full Death Benefit
80.0% 80.0% 80.0%
Graded Death Benefit 80.0% 80.0%
Full Death Benefit 2.0o/o
2.QYo
Graded Death Benefit
1.0% 1.0%
2.O%
Single Premium 13.O% 8.0% 6.0%
Commission Payments Commissions are expressed as a percentage of premiums paid unless otherwise noted. First Year commissions for monthly mode policies are c a l c u l a t e da s a p e r c e n t a g eo f t h e m o d a l p r e m i u m ,m u l t i p l i e db y t h e n u m b e ro f m o n t h si n t h e C o m m i s s i o nA d v a n c e P e r i o d ,a n d a r e p a i d a t a frequency consislent with the Commission Advance Period. First Year commissionsfor all other premium modes will be paid as earned regardlessof the advance commission period selected. Renewal commissionsare calculated as a percentage of premiums credited to a policy after all premium payments due and owing the Company during the first policy year have been received. No commissionsare paid after the tenth policy year. In its sole discretionCompany may pay directly to any sub-agent any commission due the sub-agent from the agent and it may also set-off such payment or payments against any commissions due or to become due to the agent.
Commission Chargebacks All commissions will be charged back 100% when coverage is rescinded due to a contested death claim. '100% Year 1 commissionswill be charged back at any time coverage is not taken, voided, or coverage is converted and first year commission is paid on the new coverage, or if non-accidentaldeath occurs during the firsl policy year on a graded death benefit or single premium coverage. When terminationoccurs during the first policy year due to non-accidentaldeath, surrender,or lapse for nonpayment of premiums due, chargeback of commissions paid in the first policy year will be prorated monthly based on earned premiums. Termination of the Agreement shall not terminate Company's right to chargeback commissionsthat were paid by Company under the terms of said Agreement.
No commissionshallbe paidon the sale of a policy which involves the total or partialreplacementof a policy issuedby Gompanyor any of its affiliates unless specifically provided for in writing. ACCEPTED ANDAGREEDTO: AuthorizedSignature- Agent
Date
@: LifeInsuranceCompanyor Forethought NationalLifeInsurance Company Forethought PO Box216 lN 47006-02'l 6 Batesville, Fax: 800-675-7542
[email protected] AgentC3 M2112-02
@2008Forethought 0908