AIG Annuities Fixed and Income

Transcription

1 AIG Annuities Fixed and Incme We wuld like t make yur experience f becming an AIG Annuities Fixed and Incme partner an easy ne. Please find enclsed r attached (if received via ) the fllwing dcuments with instructins fr each: W 9 Agent Appintment Questinnaire (AGL) Authrizatin f Cnduct Backgrund Investigatins Ntice f Prpsed Investigative Cnsumer Reprt A Summary f Yur Rights Under the Fair Credit Reprting Act Anti Mney Laundering (AML) Verificatin this frm shuld be returned with yur certificate f cmpletin fr the curse. If yu d nt have access t a curse, we can spnsr yu thrugh LIMRA. A Cmmissin Direct Depsit Authrizatin. This frm shuld be cmpleted if yu wuld like t receive cmmissins via EFT. It is nt required. Please fax ( ) the fllwing frms t yur Agency Manager fr prcessing: W 9, Agent Appintment Questinnaire,, AML Verificatin, AML Curse Cmpletin Certificate and Cmmissin Direct Depsit Authrizatin with a vided check (if yu wish t establish EFT payments). Agents shuld nt slicit business prir t receiving their agent cde. T cnfirm yur agent cde, please e mail us at implementatin@wnl.cm. This number shuld be referenced n all plicy applicatins submitted. In additin t the appintment frms, several states have passed legislatin requiring each agent t cmplete NAIC prduct specific training prir t making a sale. These states are: AK, CA, CO, CT, DC, FL, HI, IA, ID, IL, IN, KS, KY, LA, MD, MI, MN, MS, ND, NE, NJ, OH, OR, RI, SC, SD, TX, UT, WA, WI and WV. Yu may cmplete the training by taking the Brainshark curse via the link belw: If yu have any questins cncerning the appintment frms r requirements, yu may cntact the AIG Annuities Fixed and Incme Licensing Department at (800)

2 AMERICAN GENERAL LIFE INSURANCE COMPANY INSURANCE COMPANY (AGL) AGENT APPOINTMENT QUESTIONNAIRE CONTRACTED AGENCY NAME: BROKER/DEALER: APPLICANT NAME: NICKNAME: DATE OF BIRTH: SEX: M F LAST FIRST M MAIDEN MO DAY YR Please Circle RESIDENCE: STREET SOCIAL SECURITY: CITY STATE ZIP COUNTY PLACE OF BIRTH: HOME TELEPHONE: ( ) BRANCH/BUSINESS STREET NAME BUSINESS TELEPHONE: ( ) ADDRESS: HAVE YOU EVER BEEN APPOINTED WITH AIGAIC, AGAIC OR AMERICAN GENERAL LIFE? YES NO CITY STATE ZIP LICENSE NUMBERS: (RES) NATIONAL PRODUCER # TYPE OF APPOINTMENT REQUESTED: ( ) FIXED ANNUITY LIFE: PN: STATES FOR WHICH APPOINTMENT IS REQUESTED: I UNDERSTAND NO CONTRACT EXISTS BETWEEN AGL AND ME. ANY CONTRACTUAL AGREEMENT IS BETWEEN THE AFOREMENTIONED CONTRACTED AGENCY AND ME. ALL COMMISSIONS PAYABLE ARE PAYABLE TO THE CONTRACTED AGENCY, AND THEY IN TURN ARE LIABLE TO PAY ME ACCORDING TO OUR AGREEMENT. I AGREE THAT I WILL NOTIFY AGL IN WRITING WITHIN 10 BUSINESS DAYS OF ANY INCIDENT THAT WOULD CAUSE AN ANSWER TO THE 8 QUESTIONS ON PAGE TWO TO CHANGE. AGL 261-FL (01/13) (PAGE 1 OF 2)

3 FIVE YEAR RESIDENCE HISTORY (IF MOVED WITHIN LAST 5 YEARS): STREET CITY STATE ZIP YEAR(S) STREET CITY STATE ZIP YEAR(S) FIVE YEAR EMPLOYMENT HISTORY: PRESENT COMPANY NAME ADDRESS CONTACT YEAR(S) COMPANY NAME ADDRESS CONTACT YEAR(S) COMPANY NAME ADDRESS CONTACT CONFIDENTIAL HISTORY/BACKGROUND INFORMATION: (WRITE YES OR NO IN BLANKS--EXPLAIN BELOW) 1. HAVE YOU EVER BEEN KNOWN OR CONDUCTED BUSINESS 5. HAVE YOU EVER BEEN DENIED, SUSPENDED, OR HAD RE- IN ANY NAME OTHER THAN AS SHOWN ON THIS APPLICATION? VOKED AN INSURANCE LICENSE IN ANY JURISDICTION? 2. HAVE YOU EVER DECLARED PERSONAL BANKRUPTCY? 6. HAS ANY SURETY COMPANY OR E&O CARRIER DENIED COVERAGE OR PAID OUT FUNDS ON YOUR COVERAGE? 3. HAVE YOU EVER BEEN CONVICTED OR PLED NOLO 7. ARE YOU PRESENTLY INVOLVED IN ANY LITIGATION CONTENDERE TO ANY OFFENSE OTHER THAN A MINOR CONNECTED WITH THE INSURANCE BUSINESS OR ARE TRAFFIC VIOLATION? THERE ANY UNSATISFIED JUDGEMENTS OUTSTANDING AGAINST YOU ARISING OUT OF THE INSURANCE BUSINESS? 4. HAVE YOU EVER HAD A COMPLAINT FILED AGAINST YOU OR BEEN FINED BY AN INSURANCE REGULATORY DEPARTMENT? DETAILS OF YES ANSWERS: 8. DO YOU HAVE ANY OUTSTANDING JUDGEMENTS OR LIENS? LIST TWO (2) REFERENCE CONTACTS: NAME YRS KNOWN RELATIONSHIP TELEPHONE NAME YRS KNOWN RELATIONSHIP TELEPHONE ATTESTATION: 1 I AGREE NOT TO SOLICIT BUSINESS UNTIL I HAVE BEEN NOTIFIED THAT I AM PROPERLY APPPOINTED BY AMERICAN GENERAL LIFE INSURANCE COMPANY. 2 I HEREBY CERTIFY THAT ALL MY ANSWERS TO THE QUESTIONS ON THIS QUESTIONAIRE ARE TRUE, COMPLETE AND ACCURATE. 3 THE VIOLENT CRIME CONTROL AND LAW ENFORCEMENT ACT OF 1994 ( ACT ) PROHIBITS ANYONE WHO HAS EVER BEEN CONVICTED OF A FELONY INVOLVING DISHONESTY OR A BREACH OF TRUST FROM PARTICIPATING IN THE INSURANCE BUSINESS. VIOLATORS ARE SUBJECT TO FINES AND UP TO 5 YEARS IMPRISONMENT. I CERTIFY THAT I AM IN COMPLIANCE WITH THE ACT. AGENT S SIGNATURE: DATE: AGL 261-FL (1-13) (PAGE 2 OF 2)

4 AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATIONS I hereby authrize American General Life Insurance Cmpany Insurance Cmpany ( AGL ) t investigate my backgrund, including my credit histry. As part f this investigatin, I authrize and request any present r frmer emplyer, schl, plice department, Brker/Dealer, r ther persns having persnal knwledge abut me, t furnish AGL, r any f its affiliates with which I may later seek appintment, with any and all infrmatin in their pssessin regarding me in cnnectin with an applicatin fr emplyment, agent cntract, license, r appintment. I am willing that a phtcpy f this authrizatin be accepted with the same authrity as the riginal, and I specifically waive any written authrized request. I understand this authrizatin is t be part f the written emplyment/cntract applicatin which I sign. I authrize AGL and any f its affiliates that appint me t reprt infrmatin abut earnings and debt balances t any credit bureau r similar rganizatin. I authrize AGL t share backgrund, licensing, applicant data, and ther infrmatin that AGL has abut me with any f AGL s affiliates with which I may seek appintment in the future. I have been given a stand-alne cnsumer ntificatin that a reprt will be requested and used fr the purpse f evaluating me fr emplyment, prmtin, reassignment, r retentin as an emplyee r fr eligibility fr a license/appintment required by law t cnsider an applicant s financial respnsibility. Print Name Signature Date f Birth (fr identificatin purpses nly) Scial Security Number (fr identificatin purpses nly) Drivers License Number and state (fr identificatin purpses nly) If name changed (thrugh marriage r therwise) print frmer name here

5 NOTICE OF PROPOSED INVESTIGATIVE CONSUMER REPORT Thrughut this dcument, American General Life Insurance Cmpany disclses t yu that an investigative cnsumer reprt is being btained frm a cnsumer agency fr the purpse f evaluating yu fr emplyment, cntracting, prmtin, reassignment r retentin as an emplyee and/r fr eligibility fr a license/appintment required by law t cnsider an applicant s financial respnsibility. This reprt may cntain infrmatin bearing n yur credit wrthiness, credit standing, credit capacity, character, general reputatin, persnal characteristics, r mde f living frm public recrd surces r thrugh persnal interviews with yur neighbrs, friends, r assciates. Yu have a right t request in writing (within a reasnable perid f time) additinal detailed infrmatin abut the nature and scpe f this investigatin. Para infrmacin en espanl, visite escribe a la FTC Cnsumer Respnse Center, Rm 130-A 600 Pennsylvania Ave. N.W., Washingtn, D.C

6 A Summary f Yur Rights Under the Fair Credit Reprting Act The federal Fair Credit Reprting Act (FCRA) prmtes the accuracy, fairness, and privacy f infrmatin in the files f cnsumer reprting agencies. There are many types f cnsumer reprting agencies, including credit bureaus and specialty agencies (such as agencies that sell infrmatin abut check writing histries, medical recrds, and rental histry recrds). Here is a summary f yur majr rights under the FCRA. Fr mre infrmatin, including infrmatin abut additinal rights, g t r write t: Cnsumer Respnse Center, Rm 130-A, Federal Trade Cmmissin, 600 Pennsylvania Ave. N.W., Washingtn, D.C Yu must be tld if infrmatin in yur file has been used against yu. Anyne wh uses a credit reprt r anther type f cnsumer reprt t deny yur applicatin fr credit, insurance, r emplyment r t take anther adverse actin against yu must tell yu, and must give yu the name, address, and phne number f the agency that prvided the infrmatin. Yu have the right t knw what is in yur file. Yu may request and btain all the infrmatin abut yu in the files f a cnsumer reprting agency (yur file disclsure ). Yu will be required t prvide prper identificatin, which may include yur Scial Security number. In many cases, the disclsure will be free. Yu are entitled t a free file disclsure if: a persn has taken adverse actin against yu because f infrmatin in yur credit reprt; yu are the victim f identify theft and place a fraud alert in yur file; yur file cntains inaccurate infrmatin as a result f fraud; yu are n public assistance; yu are unemplyed but expect t apply fr emplyment within 60 days. In additin, by September 2005 all cnsumers will be entitled t ne free disclsure every 12 mnths upn request frm each natinwide credit bureau and frm natinwide specialty cnsumer reprting agencies. See fr additinal infrmatin. Yu have the right t ask fr a credit scre. Credit scres are numerical summaries f yur creditwrthiness based n infrmatin frm credit bureaus. Yu may request a credit scre frm cnsumer reprting agencies that create scres r distribute scres used in residential real prperty lans, but yu will have t pay fr it. In sme mrtgage transactins, yu will receive credit scre infrmatin fr free frm the mrtgage lender. Yu have the right t dispute incmplete r inaccurate infrmatin. If yu identify infrmatin in yur file that is incmplete r inaccurate, and reprt it t the cnsumer reprting agency, the agency must investigate unless yur dispute is frivlus. See fr an explanatin f dispute prcedures. Cnsumer reprting agencies must crrect r delete inaccurate, incmplete, r unverifiable infrmatin. Inaccurate, incmplete r unverifiable infrmatin must be remved r crrected, usually within 30 days. Hwever, a cnsumer reprting agency may cntinue t reprt infrmatin it has verified as accurate. Cnsumer reprting agencies may nt reprt utdated negative infrmatin. In mst cases, a cnsumer reprting agency may nt reprt negative infrmatin that is mre than seven years ld, r bankruptcies that are mre than 10 years ld. Access t yur file is limited. A cnsumer reprting agency may prvide infrmatin abut yu nly t peple with a valid need -- usually t cnsider an applicatin with a creditr, insurer, emplyer, landlrd, r ther business. The FCRA specifies thse with a valid need fr access.

7 Yu must give yur cnsent fr reprts t be prvided t emplyers. A cnsumer reprting agency may nt give ut infrmatin abut yu t yur emplyer, r a ptential emplyer, withut yur written cnsent given t the emplyer. Written cnsent generally is nt required in the trucking industry. Fr mre infrmatin, g t Yu may limit prescreened ffers f credit and insurance yu get based n infrmatin in yur credit reprt. Unslicited prescreened ffers fr credit and insurance must include a tll-free phne number yu can call if yu chse t remve yur name and address frm the lists these ffers are based n. Yu may pt-ut with the natinwide credit bureaus at OPTOUT ( ). Yu may seek damages frm vilatrs. If a cnsumer reprting agency, r, in sme cases, a user f cnsumer reprts r a furnisher f infrmatin t a cnsumer reprting agency vilates the FCRA, yu may be able t sue in state r federal curt. Identity theft victims and active duty military persnnel have additinal rights. Fr mre infrmatin, visit States may enfrce the FCRA, and many states have their wn cnsumer reprting laws. In sme cases, yu may have mre rights under state law. Fr mre infrmatin, cntact yur state r lcal cnsumer prtectin agency r yur state Attrney General. Federal enfrcers are: TYPE OF BUSINESS Cnsumer reprting agencies, creditrs and thers nt listed belw Natinal banks, federal branches/agencies f freign banks (wrd "Natinal" r initials "N.A." appear in r after bank's name) Federal Reserve System member banks (except natinal banks, and federal branches/agencies f freign banks) Savings assciatins and federally chartered savings banks (wrd "Federal" r initials "F.S.B." appear in federal institutin's name) Federal credit unins (wrds "Federal Credit Unin" appear in institutin's name) State-chartered banks that are nt members f the Federal Reserve System Air, surface, r rail cmmn carriers regulated by frmer Civil Aernautics Bard r Interstate Cmmerce Cmmissin Activities subject t the Packers and Stckyards Act, 1921 CONTACT Federal Trade Cmmissin: Cnsumer Respnse Center - FCRA Washingtn, DC Office f the Cmptrller f the Currency Cmpliance Management, Mail Stp 6-6 Washingtn, DC Federal Reserve Bard Divisin f Cnsumer & Cmmunity Affairs Washingtn, DC Office f Thrift Supervisin Cnsumer Cmplaints Washingtn, DC Natinal Credit Unin Administratin 1775 Duke Street Alexandria, VA Federal Depsit Insurance Crpratin Cnsumer Respnse Center, 2345 Grand Avenue, Suite 100 Kansas City, Missuri Department f Transprtatin, Office f Financial Management Washingtn, DC Department f Agriculture Office f Deputy Administratr - GIPSA Washingtn, DC

8 Anti-Mney Laundering Training Prgram 2014 VERIFICATION I am an appinted agent f American General Life Insurance Cmpany (AGL), merged with and successr t Western Natinal Life Insurance Cmpany and/r The United States Life Insurance Cmpany in the City f New Yrk, frmerly First SunAmerica Life Insurance Cmpany, ( US Life ) and verify that I participated in an anti-mney laundering training prgram spnsred by. Attached heret is my anti-mney laundering training certificatin f cmpletin. (Signature) (Printed Name) (Date) Yu may fax this frm, alng with the certificatin f cmpletin, t ur Licensing Department at (806) Thank yu.

9 American General Life Insurance Cmpany The United States Life Insurance Cmpany in the City f New Yrk Mailing Address: Annuity Service Center P.O. Bx 871 Amarill, TX Overnight Mailing Address: Annuity Service Center 1050 N. Western Street Amarill, TX COMMISSION DIRECT DEPOSIT AUTHORIZATION AGENT/AGENCY INFORMATION Agent/Agency Name: Scial Security #/TIN #: New Agent/Agency Existing Agent/Agency Agent/Agency #: New Depsit my cmmissin earnings with the accunt and financial institutin shwn n the attached vided check. Checking Savings Other: Name f Bank: Ruting #: Acct. #: DEPOSIT Bank Address REQUEST Change Change my current direct depsit t the new accunt and financial institutin shwn n the attached vided check. Cancel Cancel my direct depsit and send my cmmissin earnings t the address listed belw: Nte: Direct depsits must be t an accunt where the Payee s name and scial security number listed abve match thse n the accunt s recrds. Allw 10 business days fr prcessing, cancellatins, r changes. AGREEMENT I authrize the Insurer and the Bank indicated t depsit my net cmmissins autmatically int my accunt each cmmissin cycle. If funds t which I am nt entitled are depsited int my accunt, I authrize the Insurer t direct the bank t return said funds. This authrity will remain in effect until I have either cancelled it in writing r upn issuance f written ntice frm the Cmpany. AUTHORIZED SIGNATURE Agent/Agency Rep.: X Date: Name Title ATTACH A VOIDED CHECK OR A COPY OF A VOIDED CHECK TO THIS FORM. Fax r Mail t: American General Life Insurance Cmpany The United States Life Insurance Cmpany in the City r New Yrk (806) Attn: Cmmissins P.O. Bx 871 Amarill, TX AGL 105 (3/14)