Dear General Agent, Please fax all paperwork to

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1 One Financial Way Cincinnati, OH Post Office Box 237 Cincinnati, Ohio Telephone: Fax: Dear General Agent, In order to expedite the contracting process, we ask that you use the enclosed Agent Transmittal form when faxing paperwork to the Home Office. The transmittal form clearly states the paperwork that is required. The optional items relate to the Financial Arrangements/Supplements being offered to the prospective agent. The transmittal form should be removed and retained by you in order to include it when faxing in the completed paperwork. Please fax all paperwork to If you obtained this Contracting Kit from the ON-Net site: If you printed the Contracting kit from ON-Net, the kit contains this letter to you, the transmittal form, and all the required documents. The optional supplements you decide to offer can be printed from the same location on ON-Net. These forms are fillable PDF s that can be completed online, printed and then faxed. (Home» My Resources» Contracting Producers) If you obtained this Contracting Kit by ordering it from our Supply Dept.: If you have the hard copy kit received from our Supply Dept, then you will find the transmittal form and the optional supplements behind this letter. Please remove and discard any optional supplements not needed. Thanks, Your C&L Team Form 1561-GA Rev. 9/08

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3 One Financial Way Cincinnati, OH Post Office Box 237 Cincinnati, Ohio Telephone: Fax: Dear Prospective Career Agent, We are pleased that you are applying for a contract with Ohio National Financial Services. In order to process your file, we need the information listed below. All of the forms listed below are contained in this contracting kit. The other items will need to come from your office files. When these items have been gathered or completed, please return the items to your General Agent. If you have any questions regarding this information please contact your General Agent or agency office. Please complete, sign and return to your General Agent: Career Agent Personal History (Form 1514) Personal Conduct Form (Form 1591) only if you answer yes to conduct questions Signed Contract (Form 4200-CAGT) Business Practices Guide Acknowledgement (Form 2246-A) Signed Letter of Intent (Form 1560) Direct Deposit/EFT Form for Commission Payments (Form 1515) Errors & Omissions Insurance verification (GL4A 02) NOTE: Each Agent/General Agent must have Errors and Omissions Insurance to be contracted with Ohio National. o If you are applying for coverage through the Ohio National sponsored plan, please complete the attached form. o If you are continuing coverage through your current carrier, please enclose a copy of the declaration page of that coverage. Agent s Request for Group Insurance/Waiver (Form 6302) o Form GLAD-4 for group life coverage and/or Aetna Form GR for group medical coverage (if applying for coverage) ONESCO-152 Pre Hire Consent Form Please attach these items from your files to the forms listed above and return them to your General Agent: Copy of License(s) Voided Check for Direct Deposit Note: Anti-Money Laundering training must be completed using the LIMRA training course before any policies are issued or commissions are paid. Form 1561-CA Rev. 11/09

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5 The Ohio National Life Insurance Company Ohio National Life Assurance Corporation Post Office Box 237 Cincinnati, Ohio Telephone: CAREER AGENT PERSONAL HISTORY GENERAL INFORMATION Please Print CONFIDENTIAL Name (First Middle Last) (Nickname) Date of Birth Social Security Number Current Residence Address City State Zip County Length of Residence Home Phone # Business Address City State Zip County Business/Primary Phone # Business Fax # Address National Producer Number Spouse s Name Previous Residence Address (Last 5 Years) From To FAMILY STATUS Name of Persons Dependent upon you for Support (include Spouse, Children & Others) Relationship Date of Birth SOCIAL ACTIVITIES Approximately how many families do you know in your present community?* List any hobbies or special interests you have (e.g., dramatics, music, sports, etc.) List any organization of a business, club, or fraternal nature to which you belong or have belonged in the last ten years, and also list any elective or appointed positions you have held in these organizations. *(Do NOT list those activities that would disclose race, color, religion, sex, national origin or handicap). List any community activities in which you have participated (e.g., United Way, Local Government, etc.) Explain: Form 1514 Rev. 10/11 CL CONTRACT (C) PERSHIST (S) Page 1 of 7

6 EDUCATION High School School Name, City, and State Principal Courses Taken No. Years Attended Degree Conferred College Other Business, Sales Or Life Insurance Courses In what extra curricular activities did you participate? Describe any part-time jobs (or summer work) while attending high school or college. EXPERIENCE Give complete business experience with your last 4 employers or for the last 10 year period. Include both full and part-time employment, educational, military and unemployment (exceeding one month) history. List the latest period first. Include commissions in annual earnings. (Indicate Mo/Yr) Company Name & Address Position Reason for Leaving From Annual Earnings $ To Name of Supervisor May we contact? Yes No From To Annual Earnings $ Yes No From To Annual Earnings $ Yes No From To Annual Earnings $ Yes No REFERENCES Give name, address, phone no. and occupation of at least two professional or business leaders in your community (not relatives) who can attest to your character and reputation. NAME ADDRESS PHONE NUMBER OCCUPATION Form 1514 Rev. 10/11 Page 2 of 7 CL CONTRACT (C) PERSHIST (S)

7 OTHER FACTORS Personal Life Insurance In Force Amount and Type Company Personal Health Insurance In Force Amount and Type Company Disability Income Insurance In Force Amount and Type Company List any Financial Institutions with whom you deal. Will or do you have other business interests? Yes No If yes, please explain: Do you owe money to any insurance company, e.g., personally repayable debit balances? Yes No If yes, please explain: PERSONAL PRODUCTION RECORD (Last 4 Calendar Years) Life Insurance Commissions Individual DI/Health Commissions Annuity Commissions Paid Cases *Please include Production and Persistency Documentation Complete For Prior Experience Current Last Year 2 Years Ago 3 Years Ago Persistency (13 Month) Are you a FINRA registered representative? Yes No If yes, Name of B/D Most recent calendar year gross sales concessions were: Variable Life Variable Annuity Mutual Funds Limited Partnership General Securities Wrap RIA Activities Will you change your registration to ONESCO? Yes No Now under contract with what Company(ies)? Pension vested? Yes No Commissions vested? Yes % No Form 1514 Rev. 10/11 Page 3 of 7 CL CONTRACT (C) PERSHIST (S)

8 If inexperienced, why are you considering life insurance as a career? If experienced, why are you considering Ohio National? PERSONAL CONDUCT Have you ever, after trial or by pleading guilty or no contest, been convicted of a felony or of a criminal charge involving forgery, fraud, theft, defamation, violence against persons or property or unethical or anti-competitive practices? Yes No Have you ever, been charged with misconduct by, or fined or disciplined by, a governmental or self-regulatory agency (such as a state insurance department, SEC, FINRA, etc)? Yes No Have you ever been or are you now involved or threatened with civil legal proceedings or bankruptcy or creditor protection proceedings? Yes No Do you have unsatisfied judgments or liens against you? Yes No Have you ever been or are you now involved in any stranger-owned life insurance (STOLI) or annuity transactions, or any life settlement activity (e.g., soliciting, brokering, providing referrals, etc.)? Yes No Have you ever been denied coverage under a fidelity bond or was a claim ever filed or loss ever paid under a fidelity bond due to an act or omission by you? Yes No Are you now subject to any complaint or investigation that could result in a yes answer to any of the above questions? Yes No Have you ever been contracted with Ohio National? Yes No Have you ever been denied to be contracted or been terminated for cause by another insurance company? Yes No If any of the above questions are answered yes, please attach a detailed explanation, using Form 1591 including names, places, dates and all relevant facts and circumstances. NOTICE In connection with this application, an investigative consumer report may be prepared that will provide applicable information concerning your character, general reputation, personal characteristics and mode of living. This information may be obtained through personal interviews with your friends, neighbors, and associates. Upon written request, additional information as to the nature and scope of any inquiry, if one is made, will be provided. You will be required to the background authorization form (included). I understand that any misrepresentation or omission of facts set forth in this application is sufficient cause for cancellation of any contract entered into the Company in reliance thereon. Date Signature I have reviewed the above Agent s Personal History Form, and I hereby certify that the information and answers to questions provided herein are true and correct to the best of my knowledge and belief, and I hereby recommend the agent for appointment by the Company. Date General Agent Agency Code Form 1514 Rev. 10/11 Page 4 of 7 CL CONTRACT (C) PERSHIST (S)

9 DISCLOSURE AND FEDERAL FAIR CREDIT REPORTING ACT (FCRA) Disclosure We (The Ohio National Life Insurance Company the Company ) will obtain one or more consumer reports or investigative consumer reports (or both) about you for employment purposes. The reports will include information about your character, general reputation, personal characteristics, sales results and practices, and mode of living. We will obtain these reports through a consumer reporting agency. Our current consumer reporting agency is General Information Services Inc.; however, we reserve the right to use any consumer agency ( the vendor ) selected by the Company. GIS s address is P.O. Box 353, Chapin, SC 29036GIS s telephone number is (866) GIS s website is at To prepare the reports, GIS or other vendor may investigate your education, work history, professional licenses and credentials, references, criminal record, lawsuits, driving record, credit history, and any other records with public or private information sources. You may inspect GIS s files about you (in person, by mail, or by phone) by providing identification to GIS. If you do, GIS will provide you help to understand the files, including trained personnel and an explanation of any codes. Another person may accompany you by providing identification. If GIS obtains any information by interview, you have the right to obtain a complete and accurate disclosure of the scope and nature of the investigation performed. The Federal Trade Commission provides a summary statement of your rights on its website at In addition, that summary statement appears below. Para informacion en espanol, visite o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days.in addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. Form 1514 Rev. 10/11 Page 5 of 7 CL CONTRACT (C) PERSHIST (S)

10 You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at OPTOUT ( ). You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS: Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) State-chartered banks that are not members of the Federal Reserve System Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 CONTACT: Federal Trade Commission: Consumer Response Center FCRA; Washington, DC Office of the Comptroller of the Currency; Compliance Management, Mail Stop 6-6; Washington, DC 20219; Federal Reserve Consumer Help (FRCH); P O Box 1200; Minneapolis, MN 55480; Telephone: ; ConsumerHelp@FederalReserve.gov Office of Thrift Supervision; Consumer Complaints; Washington, DC 20552; National Credit Union Administration; 1775 Duke Street; Alexandria, VA 22314; Federal Deposit Insurance Corporation; Consumer Response Center, 2345 Grand Avenue, Suite 100; Kansas City, Missouri ; Department of Transportation; Office of Financial Management; Washington, DC 20590; Department of Agriculture; Office of Deputy Administrator GIPSA; Washington, DC 20250; Form 1514 Rev. 10/11 Page 6 of 7 CL CONTRACT (C) PERSHIST (S)

11 DISCLOSURE AUTHORIZATION By signing below, you authorize: (a) GIS or any consumer reporting agency selected by the Company ( the vendor ), to request information about you from any public or private information source; (b) anyone to provide information about you to GIS or other vendor; (c) GIS or other vendor to provide us one or more reports based on that information; and (d) the Company to share those reports with others for legitimate business purposes related to your application for an agent contract. You acknowledge receiving the Federal Trade Commission s Summary of Your Rights under the Fair Credit Reporting Act. You acknowledge that a fax, image, or copy of this authorization is as valid as the original. You make this authorization to be valid for as long as your contract remains active with the Company and for a period of 2 years thereafter. Report Copy: If you are applying for a job or live in California, Minnesota, or Oklahoma, you may request a copy of the report by checking the box. Printed name: First Middle Last Signature Date Form 1514 Rev. 10/11 Page 7 of 7 CL CONTRACT (C) PERSHIST (S)

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13 The Ohio National Life Insurance Company Ohio National Life Assurance Corporation Post Office Box 237 Cincinnati, Ohio Telephone: Personal Conduct Issues Personal Conduct Section of the Personal History Form The following information outlines the actions required if a yes answer is checked for any of the seven questions listed in the personal conduct section of the Personal History Form. Personal Conduct 1. Have you ever, after trial or by pleading guilty or no contest, been convicted of a felony or of a criminal charge involving forgery, fraud, theft, defamation, violence against persons or property or unethical or anticompetitive Yes No practices? 2. Have you ever, been charged with misconduct by, or fined or disciplined by, a governmental or self-regulatory agency (such as a state insurance department, SEC, FINRA, etc.? Yes No 3. Have you ever been or are you now involved or threatened with civil legal proceedings or bankruptcy or creditor protection proceedings? Yes No 4. Do you have any unsatisfied judgments or liens against you? Yes No 5. Have you ever been or are you now involved in any stranger-owned life insurance (STOLI) or annuity transactions, or any life settlement activity (e.g., soliciting, brokering, providing referrals, etc.)? Yes No 6. Have you ever been denied coverage under a fidelity bond or was a claim ever filed or loss ever paid under a fidelity bond due to an act or omission by you? Yes No 7. Are you now subject to any complaint or investigation that could result in a yes answer to any of the above Yes No questions? 8. Have you ever been contracted with Ohio National? Yes No 9. Have you ever been denied to be contracted or been terminated for cause by another insurance company? Yes No When the answer is yes to any of the above questions, the following is the action to be taken: 1. If a felony has been committed, we will typically not contract. For any non-felony; we need complete details including a copy of the indictment or other charging papers and a copy of the sentencing order or similar document reflecting the final disposition of the criminal charge. 2. We need complete information from the applicant and the regulatory agency. We need copies of the charge(s) and/or complaint(s), all communications with the agency and the complainant, and any and all findings, decisions or rulings from the agency. 3. If there is an open bankruptcy or other creditor protection proceeding, we will not contract. When the bankruptcy or other creditor protection proceeding is closed, we need a full explanation of the circumstances which gave rise to the bankruptcy or other creditor protection proceeding. If there is or was pending litigation, we need copies of the complaint and the answer, as well as documentation showing the current status of the case or its final disposition, if the case is no longer pending. If a civil legal proceeding is threatened, we may require copies of any communications to or from the party threatening litigation and/or to or from his or her attorney. 4. For an unsatisfied tax lien: a. If there is no repayment plan, we will not contract. b. If a repayment plan has been established, we need evidence that the payments are being made on schedule and a reasonable explanation concerning the circumstances which gave rise to the lien with any available supporting documentation. In order to verify this information, we may require the name of the IRS agent handling the case and, if so, the applicant must provide us with a written authorization for the IRS agent to release the information to us. Form 1591 Rev. 10/11 CL-CONTRACT (C) REQUIREMENT (T) DIRECTDEP (S) Page 1 of 2 (OVER)

14 5. We need a full explanation of any such activity including whether: the applicant is licensed as a life or viatical settlement broker; engages in the routine solicitation of life or viatical settlements; provides or has provided solicited or unsolicited referrals to life or viatical settlement companies; or participates in non-recourse premium financing or STOLI transactions. If the applicant is regularly engaged in the solicitation of life or viatical settlements, or regularly participates in the sale of life insurance policies or annuities on the secondary market, we will not contract. 6. We need a complete explanation with documentation. 7. We need a full explanation of any such complaint or investigation including copies or any communications to or from the party and/or the attorney making the complaint or causing and/or conducting the investigation. 8. If yes, when and why did the relationship end? 9. If yes, please provide details. PERSONAL CONDUCT ISSUES EXPLANATION FORM On the reverse is a description of our position on yes answers to one or more of the Personal Conduct questions on your Personal History form. Us the space below to give an explanation of the issue(s) and please remember to attach any additional documentation required to this form. Applicant Signature VP Approval Legal Approval Form 1591 Rev. 10/11 CL-CONTRACT (C) REQUIREMENT (T) DIRECTDEP (S) Page 2 of 2

15 The Ohio National Life Insurance Company Ohio National Life Assurance Corporation/Cincinnati Career Agent Contract You and Ohio National Form 4200-CAGT Rev. 9-13

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17 Outline of Contract Provisions I. Authority and Duties VI. Miscellaneous General Indebtedness Restrictions on Authority Assignment Documents No Waiver Funds Entire Contract Policy Delivery Applicable Law Premiums and Notes Records Fidelity Bonds and Liability Insurance II. Conduct of Business Independent Contractor Relationship Company Rules Materials and Advertising Laws and Regulations Territory and Jurisdiction Agency Affiliation Suspension Disciplinary Actions; Fines; Indemnification Confidentiality III. General Compensation Provisions Basis of Payment Changes in Compensation Provisions and Schedules Commission Chargebacks IV. Career Agent Status Requirements Service to Policyholders Fringe Benefit Programs Training V. Termination Automatic Termination Termination by Notice Final Accounting Compensation After Termination When Compensation is No Longer Payable Form 4200-CAGT Rev. 9/13 1

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19 CAREER AGENT CONTRACT SPECIFICATIONS CAREER AGENT City: County: State: The Ohio National Life Insurance Company and Ohio National Life Assurance Company (collectively the Company ) hereby appoint the Agent as its agent, subject to all of the terms and conditions of this Contract. This Contract consists of, and includes by reference, the Basic Contract, Schedules, Supplements and Endorsements and the applicable Compensation Rules and Practices, whether or not attached hereto, all of which the Agent acknowledges having received and read. I. AUTHORITY AND DUTIES 1.01 General. The Agent is authorized to solicit and complete applications for insurance policies and annuity contracts; to transmit the applications to the Home Office; to effect delivery of policies or contracts approved by the Company for issue within the time allotted by the Company as provided in the Company s business practices as published from time to time; to collect the initial premium for the policies or contracts; and to provide service to policyholders, contract owners, and beneficiaries. The Agent s authority to solicit applications and to service policies and contracts is limited to the types of policies and contracts for which a Compensation Schedule has been added to and made a part of this Contract. Further, the Agent has only the authority to represent the Company that is necessary and appropriate for the Agent to perform this Contract. No other authority shall be implied. Any express authority given to the Agent outside the terms of this Contract must be in writing signed by an authorized executive officer of the Company Restrictions on Authority. The Agent has no authority to do the following: (a) Make, modify or discharge any contract of insurance; (b) Waive any forfeiture; (c) Waive any payment due the Company; (d) Accept payment other than by means of a negotiable instrument acceptable to the Company; (e) Extend the time of payment of any premium; (f) Approve evidence of insurability; contracts, illustrations, or other written agreements; (h) Alter, modify, waive or change any of the terms, rates, or conditions of any of our advertisements or promotional materials; (i) Obligate the Company to any indebtedness incurred by the Agent; (j) Rebate commissions; (k) Deliver policies where the first premium has not been paid or the Insured is not in good health; (l) Misrepresent or omit material facts in any application or supplemental material; (m) Solicit or otherwise participate in any type of stranger-owned or investor-owned life insurance or annuity contracts or in any other type of life settlement or viatical transaction Documents. The Agent agrees to account promptly, according to the instructions of the Company, for all policies, premiums and other receipts, vouchers, drafts, monies, valuable papers, rate books, instruction manuals and computer disks and software of any kind received by the Agent from the Company, or from any person for the Company s account Funds. All funds collected or received by the Agent for payment to the Company, whether for initial premiums or otherwise, are trust funds and shall be held in a fiduciary capacity separate and distinct from the Agent s own funds or other funds. Such funds shall be transmitted promptly to the Company upon receipt. (g) Bind the Company by making or receiving any promises, representations or notices contrary to, or inconsistent with, the terms and provisions of the Company s written insurance or annuity Form 4200-CAGT Rev. 9/ Policy Delivery. Policy delivery shall be made according to Company rules and instructions and in keeping with the terms of the policy application. No policy shall be delivered after the expiration of the delivery period

20 established by the Company, nor unless and until the full initial modal premium has been paid. The Agent shall not deliver any life or disability income insurance policy unless the proposed insured is, at the time of delivery, in the same health and insurable condition as represented in the policy application Premiums and Notes. The Agent s authority to accept premium payments on behalf of the Company is limited to receipt of the initial modal premium payments necessary to place in force or to reinstate an individual policy or to effect delivery of the policy in accordance with the Company s delivery instructions. The Agent has no authority to accept notes in settlement of premiums, nor to accept premium payments for which premium notices or other billing forms are sent from the Company to the premium payor Records. The Agent shall keep a regular and accurate account of all written sales proposals made, of all correspondence, of all applications taken, of all collections made, of all policies or contracts issued and delivered, and of all service to policyholders. All records shall be open to inspection by the Company or its authorized representatives at all reasonable times Fidelity Bonds and Liability Insurance. The Agent may, at the discretion of the Company, be required: (a) to furnish a bond to the Company for the amount requested by the Company with surety or sureties satisfactory to the Company; and (b) to maintain professional liability insurance (errors and omissions insurance) in an amount and form satisfactory to the Company. II. CONDUCT OF BUSINESS 2.01 Independent Contractor Relationship. Within the scope of the authority conferred by this Contract, the Agent shall be free to exercise independent judgment as to the persons, time, place and manner of solicitation and as to the performance of this Contract generally. It is understood that the Company may make available, from time to time, its proprietary sales methods and materials or similar aids and services to assist the Agent in the conduct of business, but in no way shall such aids or services be construed as giving the Company control over the Agent s activities or the specific manner or means by which the Agent conducts business. In all respects, the relationship of the Agent to the Company in the performance of this Contract shall be that of an independent contractor and not an employee Company Rules. The Agent shall observe and conform to such rules and regulations as the Company shall publish from time to time relating to its underwriting practices, the acceptance of risks, and the delivery of policies or contracts, or otherwise relating to the general conduct of the business of the Company Materials and Advertising. No form, circular or advertisement, including, but not limited to, letterhead, business card, website, signage, listing, newsletter, announcement, script, or sales material of any kind making use of the Company s name or logo or describing or referring to the Company s products or services, or to the Agent s business or services as a representative of the Company, shall be printed, published, electronically displayed or used in any way by the Agent unless and until the same shall have been first approved in writing by the Company Laws and Regulations. The authority and duties of the Agent shall remain subject at all times to compliance by the Agent with all applicable federal, state and local laws and regulations, including, without limitation, state insurance laws and regulations and state and federal laws and regulations governing privacy and the solicitation of business by phone, facsimile or Territory and Jurisdiction. The Agent does not have exclusive rights in any territories assigned to the Agent by the Company. The Company reserves the right to appoint other agents within the territory and to do all things attendant to proper furtherance of its business. This Contract is made subject to the condition that the Company is, and shall continue to be, legally authorized to transact business in any jurisdiction to which this Contract may apply. The Company reserves the right to withdraw from all or any portion of any jurisdiction in which it is licensed to do business Agency Affiliation. The Agent is hereby assigned, for affiliation and general supervision purposes, to the General Agent who has signed this Contract recommending the Agent s appointment. The Company reserves the right to reassign the Agent to another agency or representative with the consent of the General Agent or upon termination of the General Agent s contract with the Company Suspension. The Company reserves the right to suspend this Contract and to suspend further payment Form 4200-CAGT Rev. 9/13 3

21 of compensation to the Agent for such reasonable time as may be necessary to investigate any conduct or activities of the Agent potentially affecting the Company s rights or liabilities hereunder Disciplinary Actions; Fines; Indemnification. The Company shall have the right to take disciplinary action against the Agent if the Company determines, in its sole judgment, that the Agent has engaged in misconduct detrimental to the interest of the Company, has breached this Contract, has been negligent, has violated Company rules or has engaged in misconduct in violation of fair and equitable trade practices. Disciplinary action may include the imposition of a fine against the Agent. The amount of any fine must be paid in full within 30 days after notice of the fine, either by payment in cash from the Agent or by the Agent s agreement to an immediate reduction in the compensation otherwise payable to the Agent under this Contract. The Agent agrees to indemnify the Company for any liability or expense the Company may incur as a result of any breach of this Contract, negligence or other wrongful act or omission by the Agent Confidentiality. The Agent shall take appropriate security measures to protect customer non-public personal information, as defined by the Gramm- Leach-Bliley Act of 1999 or other state or federal laws relating to privacy and security of customer information, whether the information be on a desktop computer, laptop, personal digital assistant (PDA), smartphone (such as a Blackberry or iphone) or hard copy. The Agent is responsible for consulting the laws and regulations of any state in which the Agent is licensed for specific privacy and security requirements, which may include, but not necessarily be limited to, the following: (a) measures designed to prevent accidental or unlawful destruction and unauthorized access, tampering, and copying; (b) utilizing secure user authentication protocols (such as control of user ID s and restricted access); (c) firewall protection; (d) encryption, to the extent technically feasible, of all transmitted records and files containing personal information, including personal information stored on laptops or other portable devices; (e) educating and training employees on the proper use of the computer security system and the importance of personal information security; (f) requiring third parties with whom the Agent contracts to implement and maintain appropriate security measures for personal information. If the Agent becomes aware of or suspects a privacy breach, the Agent must notify the Company immediately to enable the Company to promptly investigate. The Agent will be expected to fully cooperate with the Company during its investigation and remedial efforts. If the Company determines that the Agent is at fault, the Agent will be responsible for any costs relating to remediation. III. GENERAL COMPENSATION PROVISIONS 3.01 Basis of Payment. Commissions and other forms of compensation paid by the Company to the Agent for policies produced under this Contract by the Agent shall be determined by the terms of this Contract and by the Company s Compensation Schedules and Compensation Rules and Practices or any Supplements, which shall be deemed hereby to be added to and made a part of this Contract. Compensation shall be based on the premiums as paid to and accepted by the Company, unless otherwise expressly provided Changes in Compensation Provisions and Schedules. The Company reserves the right to change the rates of commissions, allowances, bonuses, fees or any other types of compensation, the products on which payable, and any other compensation elements or factors set forth in this Contract, by giving notice in writing of the change or by publishing notice of the change either in writing or electronically in a form of communication delivered or broadcast to agents generally. A change in compensation for any life or disability income insurance policy produced under this Contract shall be prospective and shall not affect compensation for any such policies produced under this Contract prior to the date when the change becomes effective. The Company reserves the right to withdraw from use any form of policy or contract and to establish the commissions and other compensation on products, plans or issue ages not listed in this Contract or applicable Compensation Schedules or Supplements that are now, or may hereafter be, issued by the Company Commission Chargebacks. If the Company refunds to the payor any premium paid on an insurance policy Form 4200-CAGT Rev. 9/13 4

22 or annuity contract produced by the Agent, whether the refund is made by reason of the terms of the policy or contract or otherwise, the Agent shall be charged with, and shall then repay to the Company, any commissions or other compensation previously paid to the Agent with respect to any premium so refunded. The Company reserves the right, in its sole discretion, when settling disputes, claims or complaints of policyowners or beneficiaries, to refund any premium(s) paid on an insurance policy or annuity contract produced by the Agent. Premium refunds or credits that are included as part of the death proceeds or disability benefits of any insurance policy or annuity contract will not result in a chargeback of compensation already paid to the Agent. IV. CAREER AGENT STATUS 4.01 Requirements. As minimum conditions for maintaining this Contract in effect, the Agent must meet the following requirements: (a) Best Time and Efforts. The Agent s best time and efforts shall be devoted to the performance of this Contract. (b) Meeting Social Security Definition. The Agent s entire or principal business activity shall be the solicitation of insurance policies and annuity contracts primarily for the Company, such that the Agent qualifies as a full-time life insurance salesman within the meaning of the Federal Insurance Contributions Act (FICA) for Social Security purposes. (c) Minimum Performance Requirements. The Agent must meet the Minimum Annual Requirements and Semi-Annual Requirements set forth in applicable Compensation Schedules beginning with the Calendar Year in which this Contract takes effect. The Company reserves the right at any time, by written notice to the Agent, to change the minimum requirements prospectively or to revise any Compensation Schedule prospectively by adding or substituting other requirements. The Company, in its sole discretion, may waive the requirements set forth in any Compensation Schedule. (d) Broker/Dealer Affiliation. If the Agent is registered with FINRA, the Agent must be duly licensed with The O.N. Equity Sales Company (ONESCO) in order to receive and maintain this contract unless agreed upon by an authorized executive officer of the Company Service to Policyholders. The Agent shall be available to assist, on request, in the servicing and settlement of the policies of all of the Company s policyholders in the Agent s territory, regardless of whether the policies were personally produced by the Agent or are, at the time of request, on a premium paying status. The compensation, if any, to be paid to the Agent by the Company for servicing policies not personally produced by the Agent shall be determined in accordance with the Company s published Compensation Rules and Practices Fringe Benefit Programs. While this Contract remains in effect, the Agent shall be eligible to participate in the Company s fringe benefit programs for Career Agents as made available by the Company. Participation in any particular plan shall be subject to the plan eligibility and participation requirements established by the Company or by the terms of the plan. The right to continue, change or terminate any plan or program is reserved solely to the Company Training. The Agent shall be eligible to take part in and to attend the Company s training programs and schools for career agents upon satisfying the Company s rules for participation, if any, and upon being recommended by the General Agent. Form 4200-CAGT Rev. 9/13 5

23 V. TERMINATION 5.01 Automatic Termination. This Contract shall automatically terminate when the earliest of the following occurs: (a) the death of the Agent; or (b) termination or non-renewal of the Agent s resident insurance license by applicable regulatory authorities; or (c) on the last day of February following the Calendar Year in which the Agent fails to meet the Minimum Annual Requirements described in the applicable Compensation Schedule unless waived by the Company; or (d) on the last day of July in any Calendar Year if, by July 1 of the Calendar Year, the Agent fails to meet the Semi-Annual Requirements described in the applicable Compensation Schedule unless waived by the Company Termination by Notice. This Contract may be terminated by either party, with or without cause and with or without specifying a reason, upon giving 30 days (or such longer period, if any, required by applicable state law) advance written notice to the other party. This Contract may be terminated immediately by either party upon giving written notice to the other party in the event any of the following occurs: (a) a material breach of the terms of this Contract, including any unauthorized act undertaken by the Agent, or the Agent s violation of the Company s published rules and practices relating to the conduct of its business; or (b) any act of fraud or misconduct by one party; or (c) any material violation of state insurance laws or regulations or of any other legal requirements bearing upon this Contract; or (d) any employment, undertaking or condition applicable to the Agent or to the Company that is inconsistent with the further performance of this Contract; or (e) the Agent s failure to pay a fine or to comply with any other disciplinary measures imposed by the Company in accordance with Section 2.08 above. Upon the date of notice of termination, the Agent s access to Company files and records, policy information, and any other information relating to the business of the Company shall discontinue immediately Final Accounting. Upon termination of this Contract, the Agent s authority and duties shall cease. The Agent shall then make a final report and shall turn over to the Company all monies, receipts, notes, reports, policyowner records and files, books, stationery, blank forms, computer disks and software of any kind and any other property of the Company which the Agent then or thereafter possesses or controls. The Agent acknowledges that the Company owns and has a continuing proprietary interest in policy owner records and information. Upon termination, the Agent agrees not to retain or use any policyholder records or information related to any Ohio National policyholder to solicit a replacement of any Ohio National policy. The Agent further agrees not to provide such policyholder records or information to any other person unless approved in writing by an executive officer of Ohio National Compensation After Termination. No compensation will be paid to the Agent after termination of the Contract except for those items of compensation that are identified as vested in the Company s published Compensation Schedules, Supplements or Compensation Rules and Practices. Payment of any compensation due the Agent after termination of this Contract does not, as such, give to the Agent nor imply that the Agent then has any continuing authority to represent the Company. Items of compensation not vested and, therefore, not payable after termination of this Contract shall not be available to offset any liability or indebtedness owing to the Company by the Agent. Termination will not dismiss or reduce any indebtedness the Agent owes the Company. Any indebtedness the Agent has becomes due in full upon termination or notice of termination of this Contract, whichever is earlier. This indebtedness includes, but is not limited to, any debts arising from the Agent s activities or transactions that result in an indebtedness to the Company, or from the payment of any unearned commissions or bonuses When Compensation is No Longer Payable. Notwithstanding Section 5.04 above or any other provision of this Contract or any related Compensation Schedule or Supplement, all of the Agent's rights under this Contract or any related Compensation Schedule or supplement, including the right to any further payment of commissions or other Form 4200-CAGT Rev. 9/13 6

24 compensation, shall completely cease if any of the following occurs at any time: (a) if the Agent engages in any act of fraud or misconduct; or (b) if the Agent fails to turn over any property or monies belonging to the Company or fails to make final accounting as required by Section 5.03 of this Contract; or (c) if the Agent engages in a course of conduct involving the replacement of insurance in this Company with new insurance in another company, whether or not there has been compliance with any applicable governmental regulations concerning replacements; or (d) if the Agent is terminated immediately by notice as described in Section 5.02 a) e). VI. MISCELLANEOUS 6.01 Indebtedness. All compensation payable or allowed under this Contract is subject to the right of the Company to set off against compensation all obligations and liabilities, including indebtedness, of the Agent to the Company whether arising under this Contract or otherwise. Any indebtedness owed by the Agent to the Company shall be a first lien and charge against any commissions, allowances, bonuses, fees or other types of compensation provided under this Contract. The Agent hereby assigns, transfers and sets over to the Company any monies that from time to time may become due to the Agent from the Company under this Contract or otherwise to secure any indebtedness to the Company. Indebtedness of the Agent to the Company includes any indebtedness of the Agent to an operating subsidiary or affiliate of the Company Assignment. No sale, assignment, mortgage or transfer of this Contract by the Agent, nor of any interest herein, accrued or to accrue, shall have any force or effect without the written consent of the Company No Waiver. No act or forbearance or failure to insist upon the strict performance of any of the conditions of this Contract, whether express or implied, shall be construed as a waiver by the Company of any of its rights hereunder. Payments by the Company of any commissions or other compensation to which the Agent is not entitled under the terms of this Contract shall not waive the Company s right to discontinue or recover such payments at any time Entire Contract. This Contract represents the entire agreement between the parties relating to the subject matters herein. All prior oral agreements or understandings are merged herein. No modification of this Contract, or other agreement concerning it, shall be binding on the Company unless made in writing signed by an authorized executive officer of the Company Applicable Law. This Contract shall be construed according to the laws of the State of Ohio. Form 4200-CAGT Rev. 9/13 7

25 IN WITNESS of their agreement to the terms and conditions of this Contract, the Agent and the Company have executed this Contract, on the approval date, to take effect on the effective date, together or in counterpart, by signing below. Any executed counterpart, including facsimiles, shall be deemed to be an original. All executed counterparts taken together shall constitute one contract. THE OHIO NATIONAL LIFE INSURANCE COMPANY AGENT Name (please print) By Title Vice President, Career Marketing Organization Signature Date EFFECTIVE DATE: The undersigned recommends and acknowledges this appointment. APPROVAL DATE: General Agent Date Form 4200-CAGT Rev. 9/13 8