Life Insurance Brokerage Agreement for Independent Life Insurance Agents & Brokers

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1 Life Insurance Brokerage Agreement for Independent Life Insurance Agents & Brokers Production bonus level negotiated with branch or Head Office. (Branches have a recommended bonus schedule) Excellent support with over 25 years experience as an MGA. Be part of a winning team with over 1,000 contracted life insurance brokers across Canada. Licensed in every province Ten Star Quality Companies: BMO Canada Life Standard Life Transamerica Equitable Life Manulife Foresters Life Insurance Company Penncorp / La Capitale LS Mutual Canada Protection Plan Hahn Investment Stewards Industrial Alliance RBC Life Assumption Life 1/7

2 APPLICATION FOR TEN STAR AGENT/BROKER AGREEMENT (all questions must be completed in full & full details provided) * * * * * * * * * * (A) AGENT BROKER Name: If Corporation: SIN: BIN: Date of Birth: Day Month Year Address: Office: Home: Phone: Phone: Fax: Fax: Mail or ICS: Current Life License Number: (copy of current Life License and E&O must be attached) Present Sponsoring Life Insurance Company: Previous Sponsoring Life Insurance Company: Mutual Funds Licensed? Yes No P&C Licensed? Yes No Do you sell group insurance? Yes No Were you referred to Ten Star by another broker? Yes No If so, please provide name of broker Are you affiliated with a Ten Star Branch office? Yes No If so, which branch? PRODUCTION HISTORY (MUST BE COMPLETED IN FULL WITH ALL DETAILS PROVIDED) Ins. Co s with which you ve placed business Contact Name Telephone NOTE: Please be advised a thorough background check will be conducted. We will be contacting all references to verify your volume, persistency and quality of business. In addition, life companies not listed will be contacted. Number of years you have held a Life License: Persistency rate with present Sponsor: 2/7

3 Has your life license ever been suspended or deferred? Have you ever been bankrupt? Have you ever been convicted of a criminal offence? Are you or have you ever been indebted to an insurance company? (B) THE COMPANY shall mean TEN STAR Life Insurance Brokers Inc. The Company may, at its discretion, request a consumer report. The Agent/Broker will complete contracts with the Life Insurance Companies contracted with The Company. The signing of this application represents the Agent/Broker s acknowledgement of such. DATE: SIGNATURE OF AGENT/BROKER: WITNESS: TEN STAR Life Insurance Brokers Inc. Agreement with Independent Life Insurance Agents and or Brokers IT IS HEREBY AGREED that this agreement, between: TEN STAR Life Insurance Brokers Inc. (hereinafter called The Company), and (hereinafter called the Agent/Broker) is effective from and applies to all policies placed on applications submitted to The Company on or after the said effective date. INSURANCE COMPANIES shall mean any and all Life Insurance Company or Companies issuing Life Insurance Policies or annuities solicited by the Agent/Broker, and placed through The Company. Agent Agreement shall mean the agreement between the Agent/Broker and the Life Insurance Companies. 1. ENTIRE CONTRACT: This TEN STAR Life Agent/Broker Agreement is to operate in conjunction with the Agent Agreements between the Agent/Broker and each of the Life Insurance Companies. 2. APPOINTMENT: The Company hereby appoints the Agent/Broker as an independent contractor, to solicit applications personally, and, if a corporation, to accept applications solicited by other Agent/Brokers on behalf of the Life Insurance Companies, and submit such applications to The Company for the Life Insurance Companies. 3. LICENSE: The Agent/Broker is licensed as a Life Insurance Agent under the applicable provincial law. 4. The Agent/Broker will follow the rules of The Company, and the Life Insurance Companies, published from time to time. 5. The Agent/Broker will abide by all applicable statues and regulations. 3/7

4 6. The Agent/Broker will not, in the name of The Company and in the name of the Life Insurance Companies, make, alter, or discharge any contract, accept risks of any kind, revive policies, incur any debts, or publish any advertising material respecting the business or products of The Company or the Life Insurance Companies without prior written authorization. 7. AGENT AGREEMENTS: The Agent/Broker will complete Agent Agreements, with the Life Insurance Companies. 8. COMPENSATION: First Year Commission (FYC) and renewal commissions will be paid by the Life Insurance Companies to each contracted Agent/Broker according to the provisions and schedules of the Agent Agreements. 9. (a) TEN STAR INSURANCE BROKERAGE BONUS: First year commission (FYC) paid by the Life Insurance Companies will be combined for Bonus Levels. Bonus will only be payable on bonusable commissions as stated in each life insurance companies agent agreement. The Company may from time to time modify any provisions of the bonus paid on first year commission by written notice to the Agent/Broker. The bonus level will be negotiated with the branch or head office. 10. PERSONAL GUARANTEE: The Agent/Broker acknowledges that, in consideration of The Company paying to the Agent/Broker, or to any corporation the Agent/Broker may direct payment to be made, of anticipated and advanced but unearned commissions and bonuses, and the sum of One Dollar ($1.00) now paid by The Company to the Agent/Broker, receipt whereof is jointly and severally acknowledged hereby, the Agent/Broker personally guarantees repayment of all debts and shall be liable for advanced but unearned commissions and bonuses or commissions chargebacks. This guarantee shall apply to all policies written for the Life Insurance Companies solicited by the Agent/Broker and placed through The Company. The Agent/Broker unconditionally guarantees The Company to pay all unearned commissions and bonuses and commission chargebacks upon demand. This guarantee shall survive the termination of this agreement or any agreement between the Parties. 11. ASSIGNMENT: For value received, the Agent/Broker hereby assigns to The Company all amounts of any nature or kind whatsoever owing, accruing, or which may hereafter become owing or accruing to the Agent/Broker from the Life Insurance Companies, hereinafter referred to as the debts to be a continuing security to The Company. Should the Agent/Broker be a partnership or corporation, then the individuals whose signatures appear on this agreement on behalf of such partnership or corporation personally guarantee payment to The Company of all amounts of any nature or kind whatsoever owing or accruing or which may hereafter become owing or accruing to the Agent/Broker from the Life Insurance Companies. The undersigned, Agent/Broker, acknowledges that The Company is the absolute owner of the debts and authorizes The Company to collect, demand, sue and enforce, recover and receive the debts and give valid and binding receipts and discharge therefore, without regard to the state of accounts between the Agent/Broker and The Company, and without notice to the Agent/Broker. The Agent/Broker covenants and declares that none of the debts have been assigned to or pledged or encumbered in favour of any other person, firm or corporation and the Agent/Broker covenants and agrees with The Company not to assign, pledge or encumber the debts, or any of them, so long as this Assignment remains in force, to or in favour of any other person, firm or corporation without written consent of The Company. This Assignment shall survive the termination of this or any agreement between the Parties hereto and shall bind their successors, heirs and assigns unless the Parties otherwise agree in writing with joint notice to that effect to the Life Insurance Companies 4/7

5 12. INDEMNIFYING THE COMPANY: The Agent/Broker agrees that The Company shall not be responsible for the Agent/Broker s default or neglect in the conduct of the Agent/Broker s business. The Agent/Broker agrees to indemnify The Company from and against any loss or expense incurred by The Company as a result of the Agent/Broker s default or neglect. 13. NEED ANALYSIS: The Agent/Broker agrees to provide prospective buyers of life insurance with a needs analysis before they purchase life insurance. 14. SUITABILITY: The Agent/Broker agrees to complete a Know Your Client (KYC) form before making investment recommendations for segregated funds or investments in Universal Life Policies. The investments recommended will meet the objectives and suitability determined by the completed KYC form. 15. MGA CONTRACT REQUIREMENTS: The Company MGA Contracts with each life insurance company requires The Company to provide supervision of agents of each life insurance company. The Agent/Broker will provide a copy of the needs analysis and or the completed KYC form with each application to enable the company compliance staff to be able to supervise as required. 16. CODE OF CONDUCT: The Agent/Broker will review and comply with the current code of conduct. The code of conduct may change to meet all required life insurance regulations as they are amended or changed. 17. This Agreement will terminate: (a) Automatically, if any appropriate regulatory authority in the Agent/Broker s province or territory of residence cancels or declines to renew the Agent/Broker s license; (b) Immediately upon either party giving written notice to the other in the event of fraud, insolvency or gross and willful misconduct on the part of such other party; (c) Upon either party giving written notice to the other. DATED AT THIS DAY OF 20. X AGENT/BROKER WITNESS Affix Seal X PER AGENT/BROKER (IF CORPORATION) X WITNESS Seal PRINT NAME & TITLE OF OFFICER Corporate TEN STAR INSURANCE BROKERS INC. PRESIDENT WITNESS Corporate Seal 5/7

6 CONSENT AND AUTHORIZATION To whom it may concern: I have applied to the below-named organization (the Organization ) for a contract to sell insurance and financial services products as an independent contractor or I am currently under contract to sell insurance and financial services as an independent contractor for the Organization. Part of the contracting process and the ongoing review of my performance, or my (sub)branch s performance, is an investigation of my personal background. These investigations are conducted by the Organization and/or it s authorized agent. I have sold insurance or financial services as a principal through the following business styles, trade names, corporation or partnerships ( Listed Entities ) (leave blank if none) Name Name Name From To From To From To I make this authorization on behalf of myself and as an independent contractor. I hereby authorize and direct you to release to the Organization information contained in your files concerning my (sub)branch, my employment, my business records, my education record, my credit record including records pertaining to the listed entities and / or any other information relevant to a contract to insurance and financial services as an independent contractor with the Organization. On behalf of myself and the Listed Entities, I specifically authorize the Organization to: Obtain a criminal activity clearance report from any police agency or government; information concerning certificates, licenses and registration; any information concerning complaints or disciplinary measures from regulators, industry and professional organizations and associations; Exchange information with any regulator, professional registry or database, insurance company, financial institution, mutual fund company, intermediary, personal information agents or detective and security agencies or organizations whose functions are the prevention, detection or repression of crimes or offenses, market intermediaries, managing general agents, my employer or ex-employer, including all personal information which could be collected through verification of my application for employment or contract and ongoing performance I understand that the Organization will establish a file concerning my application or a contract and subsequent performance and that the personal information contained in this file will be consulted by the organization s employees and its authorized agents in relation to my contract to sell insurance and financial services as a producer. The file will be kept at the Organization s offices. I may consult the personal information contained in this file and, if applicable, to have it rectified. A photocopy of the present consent has the same value as the original. Upon request to any professional registry or database established by the industry and holding information about me, I shall be informed of the existence, use and disclosure of personal information and I shall be given access to that information for purposes of accuracy and completeness. I further authorize the Organization to use my social insurance number in its files pertaining to me. 6/7

7 These authorizations shall be valid until the earliest to occur, of when it is revoked in writing by the Applicant, or 12 months after the Applicant ceases to receive any commission earnings from or through the Organization. Signed at, this day of, 20 Applicant s Signature: Applicant s Name Printed: Organizations: TEN STAR Insurance Brokers Inc., TEN STAR Group Benefit Specialists Inc., TEN STAR Financial Inc., TEN STAR Life Insurance Brokers Inc. 7/7

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