the independent order of foresters

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  • 8/14/2019 The Independent Order of Foresters

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    T H E I N D EP E N D E N T O R D E R O F F O R E S T E R S Producer AgreementThis Producer Agreem ent ( "Agreem ent" ) is mad e b etween The Indepe ndent Order o f Foresters("Fo resters") and(here inafter refer red to as "you" o r"your" o r "Pro duc er" ) , ef fect ive th isay o f2 01. P U R P O S EThe Agreem ent a l lows Foresters to com pensate rr \o"00-\ InSvick.r \ce M-0' the "Agency")for you r pe rsonal sales of its Ce rtif icates of Insura nce ("C ertificates") issue d b y F ore sters that are sold b yyou on beha lf of Fore sters.2. APPO I NT ME NT AND AGRE E M E NTFo resters here by a ppo ints you as a P rodu cer to solic it business on its beh alf and you a gree to repre sentFo resters as an indep ende nt contractor in accord ance w ith the term s of this Agree m ent, al l app licab leFo resters internal p olic ies, proce du res and ru les includ ing, bu t not l im ited to, the pre sentation of theFo resters Story and m em be r be nefits there in, and the La ws and re gulations of the state(s) in which y ouope rate. You a gree to subm it to such superv ision as ma y be necessary to ensure com pl iance w ith thesepolicies, pro ced ures, rules, law s and re gulations.Yo u sha ll not hav e e xclusive r ights of solic itation for any prod uct issued by F ore sters or for anygeograph ic terr itory and yo u a gree to o btain and m aintain any state insurance L icense(s) necessary tosolic it business on beha lf of Fore sters. You shall ensure tha t no individual sha ll offer o r sel l theC ertificates on you r be ha lf in any state othe r than the jurisdiction(s) in wh ich the C ertificates ma y belawful ly sold.You are not author ized to rec rui t licensed pro duce rs, or pro m ote l i fe insurance sales through o therl icensed prod ucers, on b ehalf of Fo resters.3. RELATIONSHIPYo u a re a n indepe ndent contractor and nothing in this Agreem ent, or a ny other agreem ent between yo uand Fo resters, shal l be construed to c reate the re lationship of em ployee and em ployer b etwee n you andFore sters or , if you a re a corpo rat ion, between any of ficer , employe e, l icensed produ cers or otherassociated pe rson of you rs. As an indep ende nt contractor, you a re free to op era te in the m anner youdee m app ropr iate, subjec t to the a pp l icab le law s and regulations. Yo u a re total ly responsible for a l lbu siness exp enses you incur as an indepe ndent Pro du cer .4. C OM PE NSAT I ONYou hereb y di rec t and author ize Fo resters to p ay a ny com missions, or other co m pensation if any, due onbu siness sold by you to the Agency d irect ly, and you w aive a l l r ight, t it le a nd interest to a ny com m issionsor o ther co m pe nsation from Fo resters in connection with the solicitation of bu siness and pla cem ent withFo resters. Th e am ount of any com m issions or othe r com pe nsation pay ab le to you o n Foresters businessshal l be de termined and pa id in accorda nce with yo ur contractual ar ra ngem ent with the A gency. Youunderstand and agree that you wi l l be com pensated solely by the A gency and w i ll receive nocom m issions or other co m pe nsation from Fo resters.5. L IM ITAT ION O F AUTH OR ITYYou agree not to p er form a ny acts on beha l f of Foresters for w hich you are not author ized, such as:a . Ac cep t r isks, incur de bt or l iabil ity o r m ake c ontracts in the nam e o f Fore sters;b . W aive, alter, mo dify or cha nge any Fo resters Ce rtif icate, terms, rates or cu stom ary req uirem ents;c . Endorse checks payable to Foresters;d . De live r Certificates exce pt in acc ord ance w ith Fo resters instruc tions and du ring the good h ea lth ofthe prop osed insured;e . Acc ept pre m iums exc ept for the l im ited exce pt ion of in it ia l pre m iums in acco rdance w ith F orestersproce dures, wh ich in no c i rcum stances wou ld inc lude the acce ptance of prem iums in cash;f. Ad just or sett le a ny Ce rtif icate c laim;NC P roducer 3 /09

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    g. Conduct any advertising whatsoever involving Foresters, its name or Certificates, without the priorwritten approval of Foresters; or,

    h. Notwithstanding item g. above, use Foresters trademarks, service marks, trade names, logos, or othercommercial or product designations (collectively Marks) for any purpose whatsoever without theprior written approval of Foresters. Nothing in this Agreement shall be construed as prior writtenapproval for you to use Foresters Marks.

    6. DUTIESProducer hereby agrees that its duties and responsibilities shall include, but not be limited to, thefollowing:

    a. To complete Certificate application pursuant to Foresters policies and procedures, and to notifyForesters promptly should you become aware of: the death of the applicant insured; any inaccuraciesin the applicants responses to the application; or any changes to the applicants responses generallyon the application, or as to the condition of health and insurability, before the Certificate is delivered.

    b. To submit all applications for Certificates directly to Foresters and to hold any monies collected onbehalf of Foresters and remit them promptly to Foresters.

    c. To comply with all applicable laws of each state where such Certificates are marketed and with all ofForesters rules and procedures for the sale of Certificates.

    d. To service and use best efforts to help keep the Certificates in force that you sell for Foresters.e. To obtain written approval from an officer of Foresters prior to the publication of any written

    material whatsoever regarding Foresters or its Certificates, unless such material has been furnished toProducer by Foresters for use.

    f. To provide reasonable access during normal business hours to any location, from which Producer

    conducts its business and provides services to Foresters pursuant to this Agreement, to auditorsdesignated in writing by Foresters for the purpose of performing audits for Foresters. Foresters shallgive reasonable advance written notice of an audit and include in that notice the matters that it willaudit. Producer shall provide the auditors any assistance they may reasonably require. Such auditorsshall have the right during normal business hours to audit any business record, activity, procedure, oroperation of Producer that is reasonably related to the business marketed under this Agreement,including the right to interview any personnel involved in providing or supporting suchresponsibilities.

    g. To comply with all applicable laws and regulations impacting the use and disclosure of privateinformation. In respect thereof, the Producer will: not use or disclose nonpublic personal information,i.e. personally identifiable information including, but not limited to, financial or health informationthat is not publicly available (Protected Information), about individuals who seek to obtainProducts and/or services through Foresters (Consumers), and/or members of Foresters, except asprovided herein; treat Protected Information as confidential and access to Protected Information will

    be limited to officers, employees, agents and representatives of Producer who need to use theinformation in connection with underwriting, claims administration or other servicing of Productsand/or services for a particular Consumer or member; not use or disclose, or permit any of its officers,employees, agents or representatives to use or disclose, Protected Information except: (i) asnecessary in underwriting, administering claims, or otherwise servicing the Consumer and/or membertransactions requested or authorized by the Consumer and/or member; (ii) as otherwise incompliance with the Foresters privacy policy; or, (iii) as otherwisepermitted and/or state regulationsand legislation; and, establish appropriate procedures for safeguarding Protected Information withinProducers control.

    7. SOLICITATION RIGHTSYou agree that Foresters will have, at all times both during and after the termination of this Agreement,the right to communicate in any fashion with any of the persons insured under the Certificates issuedhereunder for any purpose, including but not limited to: advertising Foresters products, benefits andservices; responding to inquiries; conservation of business; servicing the Certificates; and, adjusting claims.

    8. CONFIDENTIALITY, COMPANY PROPERTYYou understand and agree that certain information received from Foresters including, without limitation,information concerning Foresters members or customers, may be proprietary and/or confidential innature, and that you shall use all such information solely for purposes of soliciting Certificates pursuantto this Agreement.

    Foresters will furnish you such Certificates, forms, advertising matter, diskettes, and other supplies, as itmay deem necessary. The title to these Foresters materials, as well as all undelivered Certificates, bookssupplies or other property furnished to you, shall be vested in Foresters and shall be accounted for and

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    delivered to its authorized representative upon the termination of this Agreement, or at any time ondemand.

    9. INDEMNIFICATIONEach party is responsible to the other for its acts or omissions. Each party will indemnify and hold theother harmless from any loss or expenses (including attorneys fees and collection costs) resulting fromany acts or omissions of its employees and agents. This shall include any monetary fines or forfeitures,and associated administrative costs, imposed by any regulatory body by order or decree. Forestersreserves the right to withhold any amounts due from you under this provision from commissions payableto you.

    10. TERMINATION10.1 Termination Without CauseThis Agreement may be terminated without cause by you or by Foresters at any time upon written noticeby either party mailed to the other party at the last known address of such other party. Such terminationshall be effective 30 days after mailing.

    10.2 Automatic TerminationThis Agreement will automatically be terminated upon: your death (upon dissolution if a partnership orcorporation); filing for bankruptcy, insolvency or assignment for the benefit of creditors; failure tocontinuously maintain all required licenses; or, upon the termination of Foresters Agreement with yourNational Marketing Organization, if any.

    10.3 Termination For CauseThis Agreement may be terminated for cause for your:

    a. material violation of any of the terms of this Agreement or of any amendment or addendummade a part hereof;

    b. neglect to report or pay to Foresters any premiums collected on its behalf;c. material violation of any state or federal law or regulation or of Foresters new business

    solicitation and application rules;d. inducing, or attempting to induce, any Certificate holder of Foresters to stop premium payments

    or surrender a Certificate, the latter which includes the withdrawal of values with the intent ofallowing the Certificate to lapse; or,

    e. providing confidential information or materials including member information acquired fromForesters to any competitor or potential competitor.

    Termination of this Agreement shall automatically terminate any supplements, addenda, amendments or

    Schedules made a part of this Agreement.

    11. ERRORS AND OMISSIONS INSURANCEYou agree to obtain and maintain errors and omissions insurance coverage providing for each policyperiod: minimum coverage of $1,000,000 for each claim; $1,000,000 claims aggregate; and, use bestefforts to require the errors and omissions insurer to provide notice to Foresters if that coverage isterminated for any reason, including a lapse for non-payment of premium.

    12. ARBITRATIONAll disputes, controversies or differences between you and Foresters, its employees or agents, which ariseunder or are related to this Agreement, including, without limitation, the construction, performance orbreach of any agreement, upon which an amicable understanding cannot be reached within 30 daysfollowing written notice of the dispute being delivered to the other party, shall, upon the written requestof either party, be settled and determined by arbitration in accordance with the commercial ArbitrationRules of the American Arbitration Association, and judgment upon the award entered by the arbitratorsmay be entered in any court having jurisdiction of these matters, with the exception that claims relatingto contractual or equitable indemnity between you and Foresters, its employees or agents, arising out ofclaims brought by third parties shall not be arbitrated, in the absence of a further agreement between theparties. Disputes relating to such claims may be resolved in the court where the third party action ispending.

    In arbitration, the parties will have the right to conduct civil discovery and bring motions, as provided bythe Federal Rules of Civil Procedure. However, there will be no right or authority for any dispute to bebrought, heard or arbitrated as a class or collective action, as a private attorney general, or in arepresentative capacity on behalf of any person. Likewise, nothing in this provision shall preclude either

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    party from obtaining any provisional remedies prior to the commencement or completion of thearbitration that are permitted under the laws of the state governing this Agreement.

    13. ENTIRE AGREEMENTYou understand that this Agreement constitutes the entire Agreement between you and Foresters andsupersedes any and all previous agreements between you and Foresters; provided however, that thisAgreement does not release you from any ongoing obligations that are owed by you to Foresters underany prior agreement. No modification or amendment of this Agreement will be valid unless in writing bya Vice President of Foresters.

    14. WAIVERFailure of Foresters to insist upon strict compliance with any provision of this Agreement or rule ofForesters shall not constitute a waiver of the provision or rule.

    15. ASSIGNMENTThe rights and benefits of Foresters under this Agreement shall be transferable, and all provisionshereunder shall inure to the benefit of, and be enforceable by, its successors and assigns.

    16. GOVERNING LAWIt is mutually agreed that all questions and issues relating to the validity of or performance under thisAgreement shall be governed by the laws of the state of the Producers principal place of business.

    17. SEVERABILITY AND SURVIVABILITY OF CONTRACTUAL PROVISIONSAll rights of Foresters will survive the termination of this Agreement and, notwithstanding the foregoing,

    Sections 6g, 7, 8, 9 and 12 shall survive the termination of this Agreement.

    The invalidity or unenforceability of any provision of this Agreement shall not affect the validity orenforceability of any other provision hereof, and any invalid or unenforceable provision shall be deemedto be severable.

    19. DUPLICATE ORIGINALSThis Agreement may be executed in two or more counterparts, each of which for all purposes, whenexecuted and delivered, shall be deemed an original and all of which shall constitute the same instrument.

    THIS AGREEMENT CONTAINS A BINDING ARBITRATION PROVISION THAT MAY BE ENFORCED BY THEPARTIES.IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.

    ________________________________ ______________________________________Witness Producer Signature

    ______________________________________Print or Type Name of Producer

    Title: _________________________________ONLY if Producer is a corporation

    Date: _________________________________

    The Independent Order of ForestersBy: ____________________________________

    Signature

    Title: ___________________________________

    Date: ___________________________________

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    F o restersInvesting Sharing Inspi r ing

    3 E A S Y S T E P S T O G E T C O N T R A C T E D W IT H F O R E S T E R S !S T E P 1O M P L E T E T H E A P P L IC A T IO N F O R C O N T R A C T A N D A P P O IN T M E N Tn C omplete this easy-to-fol low appl ication that contains both the P ersonal D isclosure informat ion and theConsent Form for a consumer report. Part I I of the appl ication is to be completed by your N M O /IMOauthorized personneln Provide complete details of any resident and n o n - r e s i d e n t l icenses on the Application for Contract andA ppointment form for the states you intend to do business with F oresters. If you do business in C onnect icut,New Mexico or Massachusetts, you need a fraternal license, a life license is not valid. C heck out the FraternalLicense Process document for complete detai ls.n Please ensure the name in which all compensation is to be paid is proper ly l icensed, or, in the case of overridesonly, is covered by the states l isted in the Override Commission Notice.S T E P 2R I N T , S I G N and P H O T O C O P Y A P P O I N T M E N T R E Q U I R E M E N T Sn P rint and complete the A ppl icat ion for C ontract and Appo intment with F oresters.n D o not complete P art I I of the A ppl ication for Con tract and A ppointment with Foresters. This is to becompleted by your N M O /IM O .n P rint and sign the W 9 R equest for Taxpayer Identi fication number and C ert if ication (not required for N Ccontracts).n Print and sign one copy of the Foresters G A or Producer Agreement.n D o not f il l in the ef fect ive da te of agreem ent. T his wi l l be com pleted by F oresters as i t wi ll be the date youare contracted by Foresters. A copy will be returned to you, once it is counter-signed by Foresters off icials.n Include the Foresters Com mission Schedule after d iscussion with your NM O /IMO .n P rovide a photocopy of your E &O cert if icate, if not covered by C alSurance's F oresters group plan, confirmingthat you have current coverage of a minimum of $1 m ill ion for each claim and $1 mil lion c laims ag gregate foreach policy period.n Include a voided check. All producers wil l be paid weekly on Fr iday 's by direct deposi t .

    S T E P 3O R W A R D A P P O I N T M E N T R E Q U I R E M E N T S F R O M S T E P 2 T O Y O U R R E C R U I T E RT he ful l contract ing & appo intment process m ust be com pleted prior to or upon your f i rst sale, or in advance ofyour f irst sale in any of the following s trict states.Connect icut*eorgiaouisianaassachusetts*N ew M ex ic o*orth C arol inaregonennsylvaniat a h*F raternal s tates require a f raternal l icense as l i fe l icense s are no t val id in a f raternal s tate.You will receive an email notification when your application is received and when your appointment has been approved. Q uest ions? C ontact a Contract Adminis trator in C ontract ing and C ompensat ion Serv ices at 1 866 466 71 66.

    May 200

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    an outing N umberccount Holder NameC h e c k in g q S a v i n g sccount N umberc c o u Foresters1Shan. ng nsprr ngApplication for Contract and Appointment with Foresters. G e n e r a l In f o r m a t io n' P r o d u c e r q General AgentSole proprietorship q PartnershipCorporationA re you the owner of the corporation? q Yes 6 /N of yes, what percentage share do you own?Licensed C orporate N ame, if applicablefkenderitleirst Nam eiddle Nameq Male q F e m a l eM r. q Mrs. q M s. q M i s sS u r n a m eaiden Name (or other name used)E m a i l A d d r e s sSocial Security NumberBirthdate (mm/dd/yyyy)M arital StatusSpouse's Name. B u s i n e s s A d d r e s s (Please note, P.O. Boxes are not a c c e p t a b l e . )A d d r e s sS u i te #ityStateZip CodePhone (F a x (C el l (( P l e a s e n o t e , P . O . B o x e s a r e n o t a c c e p t a b l e .)Current A ddressApt #ityStateZip CodePhone (H ow long at present address?ow long at previous address?P r e v i o u s A d d r e s sApt #ityStateZip Code. H ome A ddresses over las t 5 ear . Bankin In format ion (Include a voided sample check with paperwork). License Information (Include information for all states you want to write business in.) (Use section 8. if more space is required.)Effective D atelass of B usiness*xpiry Datei c e n s e T y p ei c e n s e N u m b e rq Resident q Non-Residentq Resident q Non-Residentq Resident q Non-Residentq Resident q Non-ResidentFor Florida Non-Resident please indicate applicable counties:

    *Life, Life & Health, Life & Annuity, Life, Annuity & Health, FraternalN O T E : A f ra ternal li cense is requi red to wr ite bus iness in Co nnect icut . M assachuset ts and N ew M ex ico.

    State

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    . E r r o r s a n d O m is s i o n s C o v e r a : eDo you have errors and omissions (E&0) coverage? q Yes (If yes, attach proof of current coverage and provide complete details)

    q No (If no, have you applied for Foresters' E&O G roup coverage, q Y es q N o )Coverage Amountffective D atexpiry Datearrier Nameolicy N umberertificate NumberIf no, E&O coverage is mandatory and must be in the amount of $1 million. Foresters' sponsored group E& O coverage is availableto all producers contracted with Foresters. For details and access to C alSurance's easy on-line enrollment, please go to theirwebsite at http://www.calsurance.com/iof or email [email protected] C alsurance.com or call CalSurance at 1-800-745-7189.Has any pol icy or application for E&O insurance on your behalf ever been declined, cancelled or renewal refused, or have you ever madea claim against any such policy? q Y es q N o (If yes, provide complete details in A dditional Information Section below.). P e r s o n a l D i s c lo s u r e P r o f it

    a. List other business or personal names used in the financial services sector in the last 5 years.(Corporation, business style, trade name or partnership)

    b. Driver's License Numbers s u i n g S t a tec. Are you legally entitled to work the US?Y es q N oIf you answer "yes" to any of the following questions, provide details in Add itional Information S ection below. Such disclosures arerequested in connection with your a nticipated sale of insurance prod ucts.d. Have you ever been em ployed by and/or submitted business to Foresters?Y es q N oIf yes, indicate the name through which this business was submitted.e. H ave you ever bee n charged with, convicted of, or pled guilty or no contest to a felony or misdeme anor orare any such proceedings pending?Y es q N of. Have you ever had an insurance license denied, suspended, or revoked by a state insurance department orbeen the subject of any disciplinary or administrative action, or fined or penalized or are any suchproceedings pending?Y es q N og .ave you ever had any interruptions in licensing?... ...... ... ...... ...... ...... ......... ............ ............ ..........................: 1 Y e soh. D o you have an outstanding debit balance with any insurance company?Y es q N oi. Have you ever filed for bankruptcy?Y es q N oIf yes, is the bankruptcy active or pending?Y es q N oIf no, in what year was the bankruptcy discharged?:. A d d i ti o n a l I n f o r m a t io n F r o m P r e v i o u s S e c t io nIndicate the question number you are responding to.). D e c l a r a t i o nI expressly hereby declare that the information I have provided in this Application for Contract / Appointment is com plete and accurate in everyrespect, as of the date of signing.I swear or affirm that I have read and understand the items and instructions on this document and that my answers are true and complete t o t h ebest of my knowledge. I understand that I am subject to termination if I give false or misleading answers.I agree that Foresters (hereinafter the "Company") can verify my background information using an independent source concerning my creditrecord, my business record, my record of criminal convictions, and any other information relevant to my application to and sales relationship witht h e C o m p a n y .I understand and agree that I must execute and deliver the enclosed consent and authorization to the Company.I agree to notify and provide updated information to the Company within 10 business days, should there be any change in the information providedin their application form or in my ability to legally continue to sell life insurance and health insurance.I understand that a false statement or material omission including a failure to provide updated information may disqualify me from considerationfor a contract / appointment with the Company as a Producer or result in the subsequent termination for cause of my business relationship withthe Company and may cause the Company to report me to an insurance regulator.

    Date (mm/dd/yyyy)ignature of Applicant

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    Date (mm /dd/yyyy)16 .Direct D e os i t Author izat ion

    D I R E C T D E P O S IT A

    Signature of A pplicant

    T IO

    10.N o t ic e , C o n s e n t a n d A u t h o r i z a t i o nN O T IC E A N D C O N S E N T C O N C E R N IN G C O N S U M E R R E P O R T S F O R C O N T R A C T A N D A P P O I N T M E N T A P P L IC A T I O N P U R P O S E S

    I acknowledge and understand that The Independent Order of Foresters (Foresters), either may request, or has decided to request, consumerreports or investigative consumer reports in connection with my application for contract / appointment or during the course of my contract /appointment, if any, with F oresters. Any information contained in such reports m ay be taken into consideration in evaluating my suitabilityfor contracting / appointment. S uch reports, if obtained, will be prepared by a consumer-reporting agency and may contain informationconcerning my credit standing or worthiness, character, general reputation, personal characteristics, or mode of living. The types of reportsthat may be requested, include, but are not limited to, credit reports, Vector One searches to determine the presence of any unpaid,commission-related debit balances with any insurance company, criminal records checks, court records checks, and/or summaries ofeducational and employment records and histories.The information contained in such reports may be obtained from public record sources or through personal interviews with my neighbors,friends, associates, current or former employers, or other personal acquaintances.If F oresters requests an investigative consumer report, which would include personal interviews as described above, I understand that I will,through my N ational/Independent Marketing O rganization (N M O /IMO ) that recommended me for this application for contractingappointment, receive a second notice indicating that such a report has been requested no later than three days after the request is made to aconsumer reporting agency. This additional notice, if issued, will advise me as to my further rights pertaining to investigative consumerr e p o r t s .If any adverse decision is made with regard to my application for contracting / appointment, if any, based entirely or in part on theinformation contained in a consumer report, I understand that I will be notified, through my recomm ending NM O /IMO , as to the basis of thatdecision and given a copy of the report, as well as a summary of my applicable rights through my recommending N MO /IMO . As well, inadvising the recommending N M O /IMO , of the decision to decline my application for contracting/appointment, Foresters shall have the rightto share with the recommending NM O /IMO any information contained in the consumer report or investigative consumer report as it relatesto that decision. It is further understood that Foresters is a Vector One subscriber and, upon termination for any reason, any qualifyingoutstanding debit balance may be immediately reported to Vector One and removed only when the debt has either been paid in full or meetsthe Vector One threshold.I understand my consent is required by law before Foresters may obtain a consumer report or investigative consumer report pertaining to mypotential contracting / appointment or actual contracting / appointment, if any, with Foresters or for Foresters to share informationcontained in the consumer report or investigative consumer report with the recommending NM O /IMO .

    C O N S E N T S T A T E M E N TI have carefully read and understand this Notice and Consent form and, by my signature below, consent to the release of consumer orinvestigative consumer reports, as defined above, to The Independent Order of Foresters (Foresters) in conjunction with my application forcontracting / appointment or in connection with any future decisions concerning my contracting / appointment with Foresters, if any. I alsoconsent and direct any and all notices, copies of reports and a summ ary of applicable rights, as defined above, to be sent by Foresters, as wellas consent to the release of information contained in the consumer report or investigative consumer report, to the NM O /IMO thatrecommended me for this application for contracting appointment.I further understand that this consent will apply during the course of my contracting / appointment with Foresters, should I obtain suchcontracting / appointment, and that such consent will remain in effect indefinitely until revoked in a written document signed by me. Ifurther understand that any and all information contained in my contracting / appointment application or otherwise disclosed to Foresters byme may be utilized for the purpose of obtaining the consumer reports or investigative consumer reports requested by Foresters, and confirmthat all such information is true and correct.

    The payor, The Independent Order of Foresters, is hereby asection 4. Banking Information, credit paymentany commission payment entry ma

    Date (mm/dd/yyyy)ignature of A pplicanted to deposit on my behalf with the fin institution designated inn account of commission earnings, and if necessary, to adjusrror to my account. reverse a deposit for

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    12. a A n t i -Mon e L a un de r i n T r a i n i nHave you taken AML training?

    Yes, I have taken AML training. Please complete 12. b) Certification of Anti-Money Laundering TrainingNo, I have not completed the required AML training.Foresters will be in touch with you by email following receipt of your appointment paperwork and will provide you with instructionsto take the required A ML training through LIMR A.

    12. b Cer t i f ica t ion of An t i -Mon e Laun der in Tra in inCER TI F ICAT I ON of ANT I -MO NEY L AU N DER I NG TRAI N I NG

    Pursuant to United States regulatory requirements for insurance producers to complete anti-money laundering (AML) training on anannual basis, I certify that I have completed the required A ML training within the 12 months preceding the date of this certification.Please provide details below:( i )have completed the required A ML training through: (check as applicable)

    q L I M R AF I N R A e g E d s p o n s o r e d b y C U S O360 Trainingq O ther (please provide details in the form of copies of course m aterials)(ii) Approximate date of most recent completion of AM L training:Foresters reserves the right to verify the information outlined herein and to require you to immediately complete appropriateAM L training if such training has in fact not been com pleted within the 1 2 months preceding the date of this certification.

    Date (mm/dd/yyyy)ignature of ApplicantMIE2IMMEHave you written any Foresters new business that you have submitted or will be submitting?N o

    L ie sApplication signed date for the earliest piece of new business written:State in which new business was written in:Has new business been submitted to Foresters for processing?Y e s q No May 2009

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    Form W -9(R e v . O cto b e r 20 0 7 )Depar tment o f the TreasuryIn terna l Revenue Serv ice

    R e q u e s t f o r T a x p a y e rive form to theI d e n t if ic a t i o n N u m b e r a n d C e r t if ic a t io nequester. Do notsend to the IRS.a )o )a sac02a o

    8 2: ' 8 'cr. ,F0 .)0 .

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    N am e ( as s hown on y our inc om e t ax r e t u r n )

    B us ines s nam e, i f d i ff e r en t f rom abov e

    Chec k appr opr ia t eqimited liabilityqther (see inst r uctions)box: Nndividual/Sole proprietor.orporat ionartnership 10)ompany. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) ExemptMil payeeAddress (number, street, and apt. or suite no.) R eq ues t er 's nam e and addr es s ( op t iona l )City, state, and ZIP codeL is t ac c ount num ber ( s ) her e ( op t iona l )

    Part I Taxpayer Identification N u m b e r ( T I N )Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoidbackup withholding. For individuals. this is your social security number (SSN). However, for a residentalien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it isyour employer identification number (EIN). If you do not have a number, see Now to get a TIN o n p a g e 3 .Note. If the account is in more than one name, see the chart on page 4 for guidelines on whosenumber to enter.

    Social security number

    o rEmployer identification number

    Part II CertificationUnder penalties of perjury, I certify that:1 . The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and2 . I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the InternalRevenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS hasnotified me that I am no longer subject to backup withholding, and3 . I am a U.S. citizen or other U.S. person (defined below).Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backupwithholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirementarrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you mustprovide your correct TIN. See the instructions on page 4.

    Signature ofU.S. person ate S i g nH e r e

    G e n e ra l I n s t ruc t io n sSection references are to the Internal Revenue Code unlessotherwise noted.P u r p o s e o f F o r mA person who is required to file an information return with theIRS must obtain your correct taxpayer identification number (TIN)to report, for example, income paid to you, real estatetransactions, mortgage interest you paid, acquisition orabandonment of secured property, cancellation of debt, orcontributions you made to an IRA.

    Use Form W-9 only if you are a U.S. person (including aresident alien), to provide your correct TIN to the personrequesting it (the requester) and, when applicable, to:1 . Certify that the TIN you are giving is correct (or you arewaiting for a number to be issued),2 . Certify that you are not subject to backup withholding, or3 . Claim exemption from backup withholding if you are a U.S.exempt payee. If applicable, you are also certifying that as aU.S. person. your allocable share of any partnership income froma U.S. trade or business is not subject to the withholding tax onforeign partners' share of effectively connected income.

    Note. If a requester gives you a form other than Form W-9 torequest your TIN, you must use the requester's form if it issubstantially similar to this Form W-9.

    Definition of a U.S. person. For federal tax purposes, you areconsidered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created ororganized in the United States or under the laws of the UnitedStates, An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section3 0 1 . 7 7 0 1 - 7 ) .Special rules for partnerships. Partnerships that conduct atrade or business in the United States are generally required topay a withholding tax on any foreign partners' share of incomefrom such business. Further, in certain cases where a Form W-9has not been received, a partnership is required to presume thata partner is a foreign person, and pay the withholding tax.Therefore, if you are a U.S. person that is a partner in apartnership conducting a trade or business in the United States,provide Form W-9 to the partnership to establish your U.S.status and avoid withholding on your share of partnershipincome.

    The person who gives Form W-9 to the partnership forpurposes of establishing its U.S. status and avoiding withholdingon its allocable share of net income from the partnershipconducting a trade or business in the United States is in thefollowing cases: The U.S. owner of a disregarded entity and not the entity,

    Cat. No. 10231Xorm W-9 (R e v . 1 0 - 20 0 7 )

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    F o r e s t e r s 1.roesting Shutng , insvadv

    T H E I N D E P E N D E N T O R D E R O F F O R E S T E R S Ge n e r a l A g e n t A g r ee m e n t

    This G eneral Agent Agreement ("A greement") is made between The Independent Order of Foresters("Foresters") and(hereinafter referred to as "you" o r"your" or "General Agent"), effective thisay of2 01. P U R P O S EThe Agreem ent allows Foresters to compensate you for the production of insurance business("Certificates") issued by Foresters that are sold by you, and licensed producers recruited by you or underyour management, on behalf of Foresters.2. A P P O I N T M E N T A N D A G R E E M E N TForesters hereby appoints you as a General Agent to solicit business on its behalf and you agree torepresent Foresters as an independent contractor in accordance with the terms of this Agreement, allapplicable Foresters internal policies, procedures and rules including, but not limited to, the presentationof the Foresters Story and member benefits therein, and the laws and regulations of the state(s) in whichyou operate. You agree to submit to such supervision as m ay be necessary to ensure compliance withthese policies, procedures, rules, laws and regulations.You shall not have exclusive rights of solicitation for any product issued by Foresters or for anygeographic territory and you agree to obtain and maintain any state insurance license(s) necessary tosolicit business on behalf of Foresters. You shall ensure that no individual shall offer or sell theC ertificates on your behalf in any state other than the jurisdiction(s) in which the C ertificates may belawfully sold.You are authorized to recruit licensed producers on behalf of Foresters and to promote life insurance salesthrough such licensed producers. Licensed producers recruited by you for Foresters are subject toapproval by Foresters and will be contracted by Foresters. For purposes of this Agreement, the term"licensed producers" includes any individual, corporation or other entity contracted by F oresters on whichyou are eligible to receive a commission.3. RELATIONSHIPY ou are an independen t contractor and nothing in this Agreem ent, or any other agreement between youand Foresters, shall be construed to create the relationship of employee and employer between you andForesters or, if you are a corporation, between any officer, employee, licensed producers or otherassociated person of yours. As an independent contractor, you are free to operate in the manner youdeem a ppropriate, subject to the applicable laws and regulations. You are totally responsible for allbusiness expenses you incur as an independent General Agent.4. C O M P E N S A T I O N4.1 G eneralForesters agrees to pay you first-year and any renewal commissions, as well as override commissions("compensation") on business sold by you ("Personal P roduction") and licensed producers recruited byyou or under your manage ment, if any, in connection with Certificates issued by F oresters pursuant toapplications secured by you or your licensed producers and on premiums paid to F oresters. Suchcompensation will be paid in the amount and under the terms as provided by the applicable Com missionSchedule then in effect pursuant to, and made a part of, this Agreement. The Commission Schedule statesthe required repayments of compensation ("chargebacks") for lapsed, terminated or surrenderedCertificates. Any and all chargebacks made pursuant to this Agreement and the Commission Schedulethereto shall be "Indebtedness" and subject to S ection 11 of this A greement.It is understood and agreed that Foresters may change the Comm ission S chedule in any manner at anytime without notice, in its sole discretion; however, any su ch change will only affect Certificates with anapplication signed date on and after the effective date of the change. You agree that notice of any changein the C ommission S chedule to you by electronic transmission (email) is effective notice to you.General Agent 3/09

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    4.2 Payment of CompensationPaym ent of compensation will be made weekly, subject to change upon written notice by F oresters.C ompensation statements and produ ction reports will be provided to you pursuant to F oresters policiesand procedures in effect, which may b e amend ed by F oresters from time to time in its sole discretion.Y ou must object to any transactions shown on the comm ission statements and production reports within60 days of receiving them or they will be deemed conclusive.4.3 V esting of C ommissionsIn the event of the termination of this Agreement other than for cause, Foresters agrees to pay you, or inthe event of death your estate, all first-year and renewal comm issions payable under this A greement. Ifyou are a corporation, commissions payable hereunder shall be paid to you, your successors or assigns.Payments after your death will cease if the Certificate holder requests a new insurance agent.In the event that this A greement is terminated for cause, no further first-year or renewal com missionsshall be payable, except for the payment of any com missions earned and accrued to date, but as yetu n p a i d .5 IM IT AT ION OF A U T HORIT YYou agree not to perform any acts on behalf of Foresters for which you are not authorized, such as:a. Accept risks, incur debt or liability or make contracts in the name of Foresters;b. W aive, alter, modify or change any F oresters C ertificate, terms, rates or customary requirements;c. Endorse checks payable to Foresters;d. Deliver Certificates except in accordance with Foresters instructions and during the good health ofthe proposed insured;e. A ccept premiums excep t for the limited exception of initial premiums in accordance with F orestersprocedures, which in no circumstances would include the acceptance of premiums in cash;f. Adjust or settle any Certificate claim;g . C onduct any advertising whatsoever involving Foresters, its name or C ertificates, without the priorwritten approval of Foresters; or,h . Notwithstanding item g. above, use Foresters trademarks, service marks, trade names, logos, or othercommercial or product designations (collectively "Ma rks") for any purpose whatsoever without theprior written approval of F oresters. Nothing in this A greement shall be construed as prior writtenapproval for you to use Foresters Marks.6. DU TIESGeneral Agent hereby agrees that its duties and responsibilities shall include, but not be limited to, thefollowing:a . To complete C ertificate application pursuant to F oresters policies and p rocedures, and to notifyForesters promptly should you become aware of: the death of the applicant insured; any inaccuraciesin the applicant's responses to the application; or any changes to the applicant's responses generallyon the ap plication, or as to the condition of health and insurability, before the C ertificate is delivered.b. To submit all applications for C ertificates directly to Foresters and to hold any m onies collected onbehalf of Foresters and remit them promptly to Foresters.c. To comply with all applicable laws of each state where such C ertificates are marketed and with all ofForesters rules and procedures for the sale of Certificates, and to immediately report to Foresters anybreach thereof by your licensed producers.d. To service and use best efforts to help keep the Certificates in force that you sell for Foresters.e. To obtain written approval from an officer of Foresters prior to the publication of any writtenmaterial whatsoever regarding Foresters or its Certificates, unless such material has been furnished to

    General Agent by Foresters for use.f. To provide reasonable access during normal business hours to any location, from which General Agentconducts its business and provides services to Foresters pursuant to this Agreement, to auditorsdesignated in writing by Foresters for the purpose of performing audits for Foresters. Foresters shallgive reasonable advance w ritten notice of an audit and include in that no tice the matters that it willaudit. General Agent shall provide the auditors any assistance they may reasonably require. Suchauditors shall have the right during normal business hours to audit any business record, activity,procedure, or operation of G eneral Agent that is reasonably related to the business marketed underthis Agreem ent, including the right to interview any personnel involved in providing or su pportingsuch responsibilities.g . T o com ply with al l applicable laws and regulations impacting the use a nd disclosure of privateinformation. In respect thereof, the G eneral A gent wil l : not use or disclose nonpublic personalGeneral Agent 3/09

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    information, i .e. personally identif iable information including, but not l imited to, f inancial or he althin formation that is not publ ic ly ava i lab le ( "P rotected In formation") , about ind iv iduals wh o seek toobta in P roducts and/or serv ices through Foresters ( "C onsumers") , and/or members of F oresters,except as provided he rein; treat Protected Informa t ion as conf ident ia l and access to ProtectedInformation wi l l be l imited to off icers, employees, agents and representatives of General Agent whoneed to u se the information in connection w ith underwrit ing, claims adm inistration or other servicingof Produ cts and/or services for a particular C onsum er or mem ber; not use or disclose, or permit anyof i ts off icers, emp loyees, agents or representat ives to use or disclose, P rotected Information except:( i ) as necessary in un derwri ting, adminis ter ing c la ims, or otherwise serv ic ing the C onsum er and/ormem ber t ransactions requested or author ized by the C onsumer and/or m ember; ( i i ) as otherwise incompliance with the F oresters privacy pol icy; or, ( ii i ) as otherwise permitted and/or state regulationsand legislation; and, establ ish appropriate procedures for sa feguarding P rotected Information withinG eneral Agent 's control.

    7 . S O L I C I T A T I O N R I G H T SY ou agree that Foresters wi l l have, at a ll t imes both dur ing and af ter the termination of th is Agreem ent,the right to communicate in any fashion with any of the persons insured under the Certi f icates issuedhereunder for any purpose, includ ing but not l imi ted to : adv ert is ing F oresters ' products, benef its andservices; responding to inquir ies; conservat ion of business; servicing the C ert if icates; an d, adjust ing claims.8. C O N F I D E N T IA L IT Y , C O M P A N Y P R O P E R T YYou understand and agree that certain information received from Foresters including, without l imitation,in formation concern ing Foresters members or customers, may be proprie tary and/or conf ident ia l innature, and that you sh al l use al l such information solely for purposes of sol ici ting C erti ficates pursuantto this Agreement.Fo resters wi l l furnish you such C erti ficates, forms, advertising m atter, diskettes, and other suppl ies, as i tmay deem necessary. T he t i t le to these F oresters materials, as wel l as al l undelivered C ert if icates, bookssupplies or other property furnished to you, shal l be vested in Foresters and shal l be accounted for anddel ivered to its authorized representat ive upon the terminat ion of th is A greem ent, or a t any t ime ondemand.9 . I N D E M N I F IC A T I O NE ach party is responsible to the other for i ts acts or om issions of its employees and agents. Each party wi l lindemnify and hold the other harmless from any loss or exp enses ( including attorney's fees and c ol lect ioncosts) resulting from any acts or omissions of i ts employees and agents. T his shal l include any monetaryf ines or forfeitures, and associated adm inistrat ive costs, impos ed by any regulatory body by order ordecree. Since F oresters may be enter ing into Producer A greements with your l icensed producers, you areresponsible and will indemnify Foresters for any acts or omissions of your l icensed producers to the sameextent as for your personal acts. Foresters reserves the r ight to withhold any am ounts due from youunder this provision from comm issions payable to you.1 0 . T E R M I N A T I O N10 .1 Termination W ithout CauseThis Agreement may be terminated without cause by you or by Foresters at any t ime upon written noticeby either party mailed to the other party at the last known address o f such other party. Su ch terminationshall be effective 30 days after mailing.10.2 Automatic TerminationTh is Ag reement w i l l automatical ly be terminated upon: your dea th (upon dissolution i f a partnership orcorporation); f i ling for ban kruptcy, insolvency or assignm ent for the benefi t of creditors; failure tocontinuously maintain al l required l icenses; or, upon the termination of F oresters A greement w ith yourN ational M arketing O rganization, i f any.10.3 Termination For CauseThis A greement may be terminated for cause for your:

    a. material v iolation of any of the terms of this Ag reemen t or of any amendm ent or addendummade a part hereof;b. neglect to report or pay to Foresters any premium s col lected on its behalf;c. material violat ion of any state or federal law or regulat ion or of Foresters n ew bu sinesssolicitation and application rules;

    G enera l A gent 3 /09

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    d . inducing, or attempting to induce, any C ert i ficate holder of Foresters to stop premium paym entsor surrende r a C erti ficate, the latter which includes the w ithdrawal of values with the intent ofallowing the Certificate to lapse.e . providing confidential information or materials including member information acquired fromFo resters to any com peti tor or potential competi tor; or,f. having carried forward in your com mission account with Foresters any Indebtedness ow ed byyou, as determined in S ection 11 o f this A greem ent, following a period of eight (8) consecutiveweeks of no f irst year comm issions paid, or to be paid as due, by F oresters to you or to anyl icensed producers for w hich you are el igible to receive comm issions from Foresters.Term ination of this A greement shal l automatical ly terminate any supplements, addenda, amendm ents orS chedules made a part of this A greement.1 1 . IN D E B T E D N E S SIt is understood and agreed that you shall be responsible to Foresters for your Indebtedness to Foresters,as well as for the Indebtedness of your l icensed producers, if any, pursuant to Section 10 vi. of thisA greemen t, whether or not termination of such l icensed producer(s) occurs. I f at any t ime yourcomm ission account with Fo resters is negative, the total negative account wi l l be carried forward andcomm issions due to you from F oresters wi l l be appl ied towards any Indebtedness a s fol lows in that order:

    a. One hundred percent 100% of your total f i rst year and renewal commissions to yourpersonal product ion Indebtedness; and,b. A percentage, as set out in your Commission Schedule, of your first year, renewal andany other commissions to your Indebtedness for any l icensed producers.Foresters is hereby given first l ien upon any amounts due you, your successors or assigns under thisA greement with Foresters as securi ty for payment of any Indebtedness owed to F oresters by you or byyour l icensed producers, if any. Any such Indebtedness shall be considered a personal debt to Foresters,and F oresters shal l have the r ight to withhold or recoup any Indebtedness due from you on or aftertermination thereof. A ny Indebtedness owe d, or becoming due, by you to Foresters under this A greementon or after termination thereof shall become immed iately due an d payable in ful l to Foresters.1 2. E R R O R S A N D O M I S S IO N S IN S U R A N C EY ou agree to obtain, and require al l l icensed produc ers recrui ted by you w ho m arket or sol ici t theCertificates to obtain, and maintain errors and omissions insurance coverage providing for each policyperiod: minimum coverage of $1,000,000 for each claim; $1,000,000 claims aggregate; and, use bestefforts to requ ire the errors and om issions insurer to provide notice to F oresters i f that coverage isterminated for any reason, including a lapse for non-payment of prem ium.1 3 . AR BI T R AT I O NAll disputes, controversies or differences between you and Foresters, its employees or agents, which ariseunder or are related to this A greem ent, including, without l imitation, the construction, performance orbreach of any agreement, upon which an am icable understanding cannot be reached w ithin 30 daysfol lowing w ritten notice of the dispute be ing del ivered to the other pa rty, shal l, upon the w ritten req uestof either party, be sett led and determ ined by arbitration in accordance with the comm ercial ArbitrationR ules of the A merican A rbi trat ion A ssociat ion, and judgmen t upon the award entered by the arbitratorsmay b e entered in any court having jurisdiction of these ma tters, with the exception that claims relatingto contractual or equitable indemnity between you and Foresters, i ts employees or agents, arising out ofclaims brought by third part ies shal l not be arbi trated, in the absence of a further agreem ent between theparties. Disputes relating to such claims may be resolved in the court whe re the third party action ispending.In arbitration, the parties wi l l have the right to conduct civ il discovery and bring motions, as provided bythe Federal R ules of C ivi l P rocedure. H owever, there wi l l be no r ight or authori ty for any dispute to bebrought, heard or arbitrated as a class or collective action, as a private attorney general, or in arepresentat ive capac ity on behalf of any person. Likew ise, nothing in this provision shal l preclude ei therparty from obtaining any provisional remed ies prior to the comm encem ent or completion of thearbitration that are permitted under the laws of the state governing this A greem ent.

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    1 4 . E N T I R E A G R E E M E N TYou understand that this Agreement constitutes the entire Agreement between you and Foresters andsupersedes any an d a l l p rev ious agreem ents between you a nd F oresters ; p rov ided how ever , that th isAgreement does not release you from any ongoing obligations that are owed by you to Foresters underany prior agreement. No modification or amendment of this Agreement will be valid unless in writing bya V ice President of Foresters.1 5 . W A I V E RFailure of Foresters to insist upon strict compliance with any provision of this Agreement or rule ofForesters shall not constitute a waiver of the provision or rule.1 6 . A S S I G N M E N TThe rights and benefits of Foresters under this Agreement shall be transferable, and all provisionshereunder shal l inure to the benefi t of, and be enforceable by, i ts successors and assigns.You may not assign any compensation paid to you by Foresters, or that will be paid to you by Foresters,or directly or indirectly sell or otherwise transfer business or the actual or potential compensation orcompensation interest from business you will solicit, sell or service on behalf of Foresters, to a third partyother than as authorized in writing by Foresters.1 7 . G O V E R N I N G L A WIt is mutually agreed that all questions and issues relating to the validity of or performance under thisAgreement shall be governed by the laws of the state of the General Agent's principal place of business.1 8 . S E V E R A B I LIT Y A N D S U R V I V A B IL IT Y O F C O N T R A C T U A L P R O V I S IO N SAll rights of Foresters will survive the termination of this Agreement and, notwithstanding the foregoing,Sections 4.2, 4.3, 6g, 8, 7, 9, 11and 13 shall survive the termination of this Agreement.The invalidity or unenforceability of any provision of this Agreement shall not affect the validity orenforceability of any other provision hereof, and any invalid or unenforceable provision shall be deemedto be severable.1 9 . D U P L I C A T E O R I G IN A L SThis Agreement may be executed in two or more counterparts, each of which for all purposes, whenexecuted and delivered, shall be deemed an original and all of which shall constitute the same instrument.T H I S A G R E E M E N T C O N T A I N S A B IN D I N G A R B I T R A T I O N P R O V I S I O N T H A T M A Y B E E N F O R C E D B Y T H EP A R T I E S .I N W I T N E S S W H E R E O F , t h e p a rt ie s h a v e e x ec u te d t h is A g r e e m e n t o n th e d a te s in d ic a te d b e lo w .

    W i tn e s seneral Agent S ignatureP r i n t or T y p e N a m e o f G e n e r al A g e n tTi t le:O N L Y i f G e n e r a l A g e n t is a c o r p o r a ti o nD a t e :The Independent O rder of ForestersBy:SignatureTitle:

    D a t e :General Agent 3/09

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    A D V A N C E C O M M I S SIO N A D D E N D U MT O T H E G E N E R A L A G E N T A G R E E M E N TB E T W E E N

    T H E IN D E P E N D E N T O R D E R O F FO RES T ERS (" Fores t e rs " )- a n d -"Gnea Agen"

    W H E R EA S Foresters and General Agent have entered in to a G eneral Agent Agreement ( "A greement") which, amongstother things, authorizes the G eneral A gent and his/her l icensed pe rsonnel to solicit applications of insurance forForesters and provides for payment of first year personal and override commissions ("commissions") by Foresters to theG eneral Agent upon sale of C ert if icates by G eneral Agent and his/her l icensed personnel as premiums are col lected andremitted to Foresters "as earned";A N D W H E R E A S the G eneral A gent wishes to modify th is as earned comm ission arrangement in order to permit h im/herto receive comm issions in advance of al l first year premiums being c ollected and remitted to Foresters;N O W TH E R E FO R E , Foresters agrees to permit commissions to be paid to the General Agent as an advance of saidcommissions being earned, subject to the following terms and conditions and approval of General Agent's SupervisingG eneral Agent ( "SG A") :1 . F or the purposes of th is Addendum , the term "C ert if icates" does not include annuities. Com missions on annuit ies areonly paid when the premium is remitted to and processed at Foresters.2 . W hen a C ert if icate is put in force according to the records of F oresters and the f irst premium has been remitted,Foresters wil l calculate the applicable commission for the first Certificate year, in accordance with these terms andconditions and the Commission Schedule in effect as of the application signed date, and wil l then advance to GeneralA gent ei ther 50%, 75% or 1 00 % (10 0% only available to the IM O level and above) of the annual ized comm issions ascalculated by F oresters, and for f irst year personal comm ission, up to a maxim um of ei ther $150 0, $250 0, or $3 500 perC erti ficate, both as approved herein by G eneral Agent 's SG A .3 . On any Certificate where the commission exceeds the lesser of the percentage or approved dollar amount to be paidas annualized, any commission above that approved percentage or dollar amount wil l be paid as earned if and when theremaining premium is paid.4 . Fo resters may, in its sole discretion and upon five (5) days w ritten notice by fax or m ail to the G eneral A gent,terminate the annu al izat ion of any and al l commissions to the G eneral A gent with respect to C ert if icates put in forcethereafter, and all commissions wil l be payable as earned on those Certificates, or may modify the terms and conditionsof th is Advance C omm ission A ddendum at any t ime. A ny m odif ications wi ll only affect C ert if icates issued on or afterthe effective date of the change.5 . This Advance Commission Addendum shall form a part of the Agreement and incorporated therein, and all the termsand conditions of the Agreement and any supplements or Commission Schedules to it shall remain in ful l force andeffect unless specifically modified in this Commission Advance Addendum.

    6 . T his Advance C ommission Adden dum shal l have no force and effect unt il accepted by F oresters. I f accepted, theAdvance Commission wil l be in force and effective on the date i t is processed by Foresters.

    G A A dvance Comm ission Addendum 0 6 M A Y 0 9

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    T he G enera l Ag ent , by exec ut ion hereof on t he dat e ind ic a ted be low, hereby ac c ept s and f u l ly unders t ands t he t e rmsand c ond i t ions o f t h is A dvanc e C omm is s ion A ddendum , and ac knowledges rec e ip t o f a s igned c opy hereof .

    G e n e r a l A g e n t S i g n a tu r erint or Type Name o f G e n e r a l A g e n tD ate :itle:O N L Y i f G e n e r a l A g e n t is a c o r p o ra t io nS uperv is ing G enera l Agent A pprova l o f bo t h :A) M a x im u m P e r c e n ta g e A d v a n c e:) 50%) 75%

    (100% only available to the IMO level and above.B) Maximum Dollar Advance:$1,500 ($2,500 ($3, 500By:SignatureTitle:D a t e :The I ndependent O rder o f Fores t ers Ac c ept anc e

    By: SignatureTitle:D a t e :G A A dvance Commission Addendum 0 6 M A Y 0 9

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    ro r e s t e r sInvesting Sharing inspiring

    OVERRIDE COMMIS S ION NOTICEA s determined by T he Indepe ndent O rder of Foresters ("F oresters") , in i ts sole discret ion, cer ta in s tates and theD ist ric t of C olumb ia (" jur isdic t ions") by their insurance laws a l low overr ide com m issions to be paid to aninsurance age ncy or agent wi thout that insurance ag ency or agen t holding an act ive l icense in thosejur isdic t ions. Foresters wi l l make overr ide commission payments to any insurance agency or agent who doesnot par t ic ipate in the sale of insurance pol ic ies, as d ef ined below, in those " inc luded jur isdic t ions", pursua nt tothe terms and condi t ions of their respect ive appointmen t agreem ent wi th Fo resters and subject to the fo l lowingaddit ional condit ions.Included jurisdictions:Alabama Connecticut Illinois Maine N orth C arolina O hio T e x a sA l a s k a Delaware I n d i a n a Maryland N e b r a s k a Oklahoma T e n n e s s e eA r k a n s a s District of Columbia I o w a Michigan N e v a d a Oregon VermontArizona F l o r i d a 2 K a n s a s Minnesota North Dakota R h o d e I s la n d WashingtonCalifornia Hawaii L o u i s i a n a M is s i s s ip p i N ew H ampshire S outh C arolina W is c o n s i n 2Colorado I d a h o M issouri N ew J ersey South Dakota WyomingExcluded jurisdictions (where active license required):G e o r g i aentuckyassachusetts M ontanaew MexicoNew Yorkennsylvaniatahirginiaest VirginiaA dditional C onditionsT he insurance a gency o r agent wi l l not "sel l, sol ic i t or negot iate" insurance b usiness in any of the abov enam ed jur isdic tions. A ddi t ional ly , in C al i fornia and T exas, the insurance ag ency or ag ent wi l l not service ort ransact mat ters subseque nt to the sale of the insurance co ntract and ar is ing ou t of it as an insurance ag entin the state.Definitions: "sel l " means to exch ange a co ntract of insurance by any m eans, for money or i ts equivalent , on behalfof an insurance company. 'so l ic it " mea ns at tempt ing to sel l insurance or asking or urg ing a person to apply for a par t icular k ind ofinsurance from a part icu lar company. "nego t iate" m eans the act of conferr ing direct ly wi th, or of fer ing ad vice direct ly to, a purchase r orprospect ive purchase r of a par t icular contract of insurance concerning a ny of the sub stant ive be nef i ts ,terms or co ndi t ions of the con tract, provided that the person enga ged in that act e i ther sel ls insurance orobta ins insurance from insurers for purchasers.

    2 Overr ide commissions are only a l lowed to be paid to incorporated insurance agencies in the States ofFlor ida and W isconsin.It is the responsibi l ity of the insurance ag ency or a gent to not i fy Foresters of l icense detai ls for l icenses h eldin any of the abov em ent ioned exc luded states (or the states of F lor ida and W isconsin for other thanincorporated insurance age ncies), or their actual holding or obtainme nt of a l icense in any o f the abovenamed included jurisdictions.Th is O ver r ide C omm is s ion N ot ic e is e f fec t ive as o f J une 1 , 200 7 and t hereaf te r , un les s amen ded orwithdrawn by F oresters a t any t ime in i ts so le d iscret ion.

    For Independent Producer use only not to be disclosed to the general public.May 2009

  • 8/14/2019 The Independent Order of Foresters

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    Foresters1 fl l i h 'nvesting Sharing Inspir ingFRATERNAL L ICENS E PROC ES SFor Conn ect icut , Ma s s a chus et t s and New MexicoIn order to sel l l i fe insurance for Foresters and receive compensat ion in Connect icut , Massachuset ts and NewM exico, producers and bu siness ent i ties must hold a f raternal li fe license and be appointed with F oresters as af raternal agent , before any sales occur.1 . C o m p l e te t h e a p p l ic a b le S t at e A p p l ic a ti o n fo r F r a t er n a l A g e n t' s L i c e ns e f o rm .2. M ake che ck or m oney order for a f raternal l icense fee paya ble in the correct am ount to the appropr iate s tatenot ed in the t ab le above. Su bmi t t he c omple t ed paperwork and c hec k/money order to :

    ForestersC o n t ra c tin g a n d Co m p e n sa t io n S e rv ice s7 8 9 Do n M i ll s Ro a dT o r o n t o , O n t a ri o , C a n a d a M 3 C 1 T 93 . License fee w i l l be re imbu rsed by F oresters fo llowing placem ent of fi rs t p iece of business with Fo resters.Foresters wi l l complete and author ize the appointment form(s) and mai l the ent i re package to the appl icableD epar t ment o f I ns uranc e. The average proc es s ing t ime f o r t he s t a te is approx imat e ly 10 bus ines s day s .S t a t e T y p e o f L i c e n s e L i c e n s e F ee P a y m e n t MadePayable to F r a t e r n a l A p p l ic a t i o n D e t a i ls a n d F o r m sR e q u i r e dC o n n e c t i c u t Indiv idual Residento r N o n - R e s i d en t $65.00 Treasurer, Stateof C onnect icu t Complete a Connect icut Fraternal L icenseA ppl ication found on the G et Cont ractedpage under Fraternal L icense Process.Business E nt ityR es i dent o r N on-R e s i d e n t

    Complete a Connect icut Business Ent i tyInsurance L icense/Reg ist ration A ppl icat ionfound on the Get Cont racted page underFraternal L icense Process.M a s s a c h u s e t t s Individual Residento r N o n - R e s i d en t

    n/ a Foresters pays$6.00appointment fee

    C o m p l e te a M a s s a c h u s e tt s F r a t e r n alL icense Appl icat ion found on the GetCont racted page under Fraternal L icenseProcess.Business E nt ityR es i dent o r N on-R e s i d e n tIn order to apply for a business ent i tyresident or non-resident l icense, contact theMassachuset ts Depar tment of Insurance forass is tance at 617 521 7794.N e w M e x i c o Indiv idual Residento r N o n - R e s i de n t $ 3 0 . 0 0 Note: A $ 3 0 . 0 0C h e c k o r M o n e yOrder areacceptedpayable to:

    New Mexi coPublicRegulat ionCommi ss i onInsuranceDivisionForesters pays$23.00appoin tment fee

    C o m p l e te a N e w M e x i co F r a te r n a l L i c e n s eA ppl ication found on the G et Cont ractedpage under Fraternal L icense Process.Note: Producers ope rat ing under acorporate nam e m ust a lso obta in abusiness ent i ty f raternal l icense in order toreceive compensat ion in that name.Business E nt i tyR es i dent o r Non-R e s i d e n t

    C o m p l e te a N e w M e x ic o B u s i n e s s E n t i tyInsurance L icense/Reg ist rat ion A ppl icationf o u n d o n t h e G e t C o n t r a c te d p a g e u n d e rFraternal L icense Process.Note : P roducers operat ing under acorporate name m ust a lso obta in abusiness ent i ty f raternal l icense in order torece ive com pensat ion in that nam e.

    Renewal fees associated with the Fraternal L icense and Appointment wi l l be the responsibi l i ty of theProducer/Business Ent i ty.For Independent Producer use on ly not to be disclosed to the general public. May 2009