WELCOME TO VANBRIDGE FIELD GUIDE FOR NAVIGATING OUR SYSTEMS AND PROCESSES.

Welcome…

On behalf of our entire team, I would like to welcome you and thank you for giving us the opportunity to

serve you. Vanbridge Insurance Services has enjoyed a long tradition of providing superior trust and

insurance advisory services. Our goal has always been to provide our clients with the services, systems and

tools to be entrepreneurial, independent and the most well respected advisors in their given markets. As a

firm who considers our business as more consultative, we strive to offer objective solutions for our clients.

Our depth of expertise includes advanced planning techniques, underwriting prowess, extensive carrier &

objective product support, case design, true marketing and sales offense/defense, back office support and

innovative technology.

Our range of products and services is broader than ever. Vanbridge’s collective firms have the capability to

bridge the languages, cultures and financial interests across the broad spectrum of traditional insurance

and capital markets to deliver significant value to our clients and partners. No one insurance broker or

investment bank currently offers this total integrated approach as a combined business enterprise—we do.

Our commitment to helping advisors and firms has never been stronger. Our success and enviable

reputation are directly attributed to the extraordinary caliber of our staff, the quality of our personal service

and the results our clients achieve. We are privileged to be associated with some of the most successful

advisors and organizations in the industry and we welcome the opportunity to be of service to you.

Sincerely,

Mitchell K. Smith Managing Principal Vanbridge LLC

Contents

Procedures .................................................................................................................................................................... 4

Getting Contracted .................................................................................................................................................. 4

Submitting Informal Business ............................................................................................................................... 5

Submitting Formal Business ................................................................................................................................. 7

Financial Underwriting ............................................................................................................................................ 8

New Business Checklist ......................................................................................................................................... 9

Department Contact Information .......................................................................................................................... 11

Trial Application ............................................................................................................................................................ 12

HIPAA ............................................................................................................................................................................. 17

Website Tools and Resources .................................................................................................................................... 21

Team Contact List ........................................................................................................................................................ 22

Processing:

PROCEDURES

Processing New Business-Life Insurance

Below are some simple procedures on how to submit new business through our offices. By following these steps, it will ensure that your application is processed as quickly as possible.

Contracting Informal Formal Financial

Submitting Contracting:

In an effort to streamline the appointment process, we are pleased to offer our online Licensing and Contracting system through SuranceBay’s Sure LC. The process leads you through a series of questions in an effort to collect all information and documentation required to complete the carrier contracting forms. The initial setup takes about 10-15 minutes to complete your profile within Sure LC. Your profile is then saved for all future appointment requests with Vanbridge Insurance Services.

Once your Sure LC profile is completed, Vanbridge will be able to generate the carrier specific contracting, on your behalf, upon request. This allows you to request appointments with multiple carriers while eliminating paperwork. Our Licensing Department will contact you via email if any missing items are required to submit an appointment request to the carrier.

Once your appointment paperwork has been submitted to the carrier, the carrier typically takes 5-7 business days to approve your appointment. Our Licensing Team will notify you upon receipt of your appointment approval. Once the first appointment is processed you will be granted access to Case Control through your VBIS website login which gives you the ability to view cases, appointments and agent codes. Please note Licensing requests are processed and prioritized by submission of new business and pre-appointment states.

For more information regarding Vanbridge’s Licensing procedures and carrier guidelines, please visit our website or contact our Licensing Team at contracting@vanbridge.com

To access our online licensing and contracting system, click here. If you prefer to fill out the forms offline, click here for a fillable PDF. If you encounter any problems during this process please contact contracting@vanbridge.com or 954-670-5191. The Licensing and Contracting team will contact you if any missing items are required for submission. The team will notify you as well with your agent code and effective date when the appointment is complete. Once first appointment is processed, you will be granted access to “Case Control”, which gives you the ability to view cases, appointments and agent codes. Once the carrier has processed paperwork and approved with agent code or “just in time” status, you will receive email from the contracting dept. Please note, items are processed and prioritized by submission of New Business and pre-appointment states.

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An overview or “brief” is created on the information received. A database is maintained on every case submitted (all pertinent information), whether it ultimately goes formal or not. The case will be entered into the on-line system within 24 hours and you or your agents will have access 24/7 through our Case Control website tools.

Please make sure that you order the medical records for all Physicians that the client lists on the trial application.

Please make sure to stress to your client that we need to know ALL the physicians he/she has seen in the last five years, not

just the primary physician. If you would prefer (assuming you have the production amount required) we will order your medical records from our office and send you an invoice for payment. If the case goes formal and is placed, the insurance company will reimburse you for the cost of those records. If the case does not place, you will not be reimbursed.

Please note that the companies will only accept trial applications on cases that are $1 million (face amount) or greater in death

benefit of permanent insurance. Insurance Companies will only accept trials on term insurance cases that have a face amount of $6 million or greater death benefit.

For some trial applications, we require third party financials from the clients CPA or attorney. Please make sure that you have

these as we will not send out the trial without them. (Life Insurance cases with a face amount of $3,000,000 or higher – underwriter’s discretion). Once you have received everything, send the trial application to our underwriting department via e-mail, fax or regular mail

(preferably e-mail). Be sure to include the HIPAA. Please be sure to list on the trial application the face amount requested, and the companies you wish to submit to. If the

companies are left blank, we will submit to the carriers we believe will be best suited for your situation.

Expected turnaround time for offers of anywhere from two to five weeks depending on the company. Please be advised that informal business can potentially take longer due to the large amount of trials the insurance companies may receive. As soon as an offer is received it will be sent to you via e-mail.

Submitting Informal Business (trial applications):

Emails are sent to underwriting@vanbridge.com Direct Fax # is (866) 208-9486 Address is 225 NE Mizner Blvd., Suite 675, Boca Raton, FL 33432 Received requests are logged and to be set-up/processed within a 24 hour turnaround time.

Informal Business (trial applications) Steps and Process:

PROCEDURES

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• The Informal Underwriters will perform a preliminary ‘scrub’ or purging of the medical file to make certain all information needed to review the case favorably has been submitted.

• Cases that are not complete will not be sent for summary. You will be contacted to obtain missing information and reminded every 5 days of this via ‘Memo’ in the online Case Control. Once this information is received, the case is then

reviewed and either sent out for summary or more information is requested. • If the Underwriting team deduces the potential offer will be highly rated upon the medical information received, (client’s

health is not favorable enough to qualify for a typical competitive offer) the case will not be sent out for informal offers, however, the case will be briefly summarized as to the issues and reasoning behind the potential offer. If the agent chooses to release the case after receiving this summary, and they believe there is a high likelihood of placing the case regardless, it will be released to the requested carriers for an “official” offer.

• Informal Underwriters (UW) will send complete client files to be summarized. These files are assigned to the Clinical Review Specialist (RN’s) for a ‘clinical’ summary.

• The Clinical Review Specialists type up a timeline synopsis of the client’s medical history. Every case that is sent informally is accompanied by a summary of the medical information in date specific and doctor specific order. In some cases, carriers will only review our summaries and not the actual medical records. Cases can be summarized in as little as a few hours and up to, but no longer than, 48 hours.

• Summary is sent to the Informal UW for final review to make certain no information has been overlooked.

• Supplementary information is added to create a story for the underwriter ultimately reviewing the file for a medical offer. Additional information, such as healthy living habits, examples of ‘good’ control for cholesterol, diabetes, blood pressure, stability of a condition, are all pointed out for a more favorable review.

• The goal is to have a complete summary in no longer than 5 days; once a summary is complete, the file is sent to the insurance carriers: Agents can dictate where a file is shopped, but if this information is not provided, the case is shopped using internal benchmarks.

Informal Business (trial applications) Steps and Process:

PROCEDURES

6

Please be sure you are licensed with Vanbridge Insurance Services LLC for each company you intend on submitting

business to. Please contact L&C if necessary (per the contracting procedure), and make sure you have an updated copy of your

insurance license and E&O. Please make sure that your application is completely filled out and all signatures have been obtained. If there are any special

forms you need (1035, replacement, etc.) please let us know ahead of time and we will provide you with the necessary paperwork—either through the forms tool on our website or via email-- most forms are available on our website.

Please make sure that the application shows that it was signed in the actual state of the application. The two must match.

If you have already ordered the medical records, please send with all other forms; although we will order the records for

formal business, this will speed the process dramatically. Please make sure that all of the client’s Physicians are listed on the application, or on a separate sheet of paper accompanying the application.

Once we have all the above information, we will submit the case for underwriting. The process normally takes anywhere from

one week to four weeks depending on the insurance company and information relayed to us in a timely manner.

Submitting Formal Business:

Emails or direct faxes should be sent to your case manager (you will have a dedicated case consultant) Address is 225 NE Mizner Boulevard, Suite 675, Boca Raton, FL 33432

Applications received are to be processed within a 24 hour turnaround time.

PROCEDURES

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Financial Underwriting:

PROCEDURES

As your advocate, as well as a partner to our insurance carriers, Vanbridge has been able to forge unique relationships and ultimately accomplish what other BGAs cannot, nor have the resources to do so. We distinguish ourselves by the work we do up front and in the way we package a case, whether it be informal or formal business. Given the environment today within the insurance industry, Vanbridge understands that in order to maintain our longevity we must, once again, be at the forefront and distinguish our service amongst others. In order to continue to provide our agents with outstanding service and receive preferential treatment from carriers, Vanbridge has adopted certain measures when addressing the following:

Insurable Interest

The purpose of financial underwriting is to verify the insurable interest of a proposed insured at the time of underwriting so that there is a clear understandingof the purpose of the insurance being purchased, as well as to verify that the beneficiaries of the policy.

There are four defined types of insurable interest: ✓ A person has an insurable interest in his/her own life. ✓ Parents have an insurable interest in the life of their child. ✓ Each spouse has an insurable interest in the life of each other. ✓ A person has an insurable interest in the life of another where there is a reasonable expectation of financial gain from continued life and a

financial loss resulting from the untimely death of the other person.

Financial Compliance

In addition to a detailed cover letter, we may require that all cases are accompanied by the following financial documentation: ✓ CPA Letter (with license # and state) – itemized list of assets ✓ Income Statement ✓ Brokerage, banks, bond, stock statements ✓ Tax Returns (past 2 years) – if the above is not sufficient ✓ If real estate comprised the bulk of assets, addresses will be required and any other information that may explain value ✓ If any valuables (car, jewelry, art, collectables) are included in the net worth, copies of appraisals and insurance policies will be needed.

Structure/Estate Planning

As you may know, insurance carriers are placing extreme scrutiny on trust documents. Control of the trust and ultimately the beneficiaries of the proceeds of the trust, must be known to determine if insurable interest exists. Before a case can be submitted, a trust document must be received and reviewed internally. VBIS will request the following information: ✓ Attorney name and address ✓ Relationship of Trustee to the insured ✓ Beneficiaries of the trust and explanations particularly if a spouse is a beneficiary ✓ Explanation of the Situs of a trust if it is outside the insured’s/trustee’s residence state

Applications with trusts that do not meet Vanbridge’s internal guidelines due to missing provisions or because requested information has not been received will not be submitted until such information is furnished. 8

Please use this as a guide when submitting business, as this will ensure we receive all the necessary requirements:

Informal checklist:

Trial application HIPAA Authorization (must be current Vanbridge HIPAA) Current Medical Records (last five years) Third Party Financials (if required) - Signed by clients CPA or Attorney. (See Trial Procedure) Death benefit greater than $1 million UL.

Formal Checklist:

Life Application (state specific) Please let your case manager know if your client participates in any hazardous activities, it may require additional forms or questionnaires. (example: pilot, scuba diving, etc.) Replacement Forms (for replacement of any in force life insurance) 1035 forms (If needed.) A 1035 exchange can only be done when there is a ‘like to like’ circumstance. The owners must always be the same; if they are not your application cannot be processed. Signed illustration or signed illustration compliance certification form Third Party Financials (if required) - Signed by clients CPA or Attorney. (See Trial Procedure) Business as Owner, an officer other than the client, MUST sign the application as Owner (including title). If insured is 100% owner,

they can sign but must sign both as insured AND owner with title. Owner is a Trust, the application MUST be dated after the Trust date.

Include tax ID#. All trustees should sign the application. Application can ONLY be dated on or after the date the trust was executed. Corporation is the owner, include tax ID#. Cash with Application:

Checks need to be made payable to the Insurance Carrier. Ensure your client’s coverage is bound by verifying the specific rules for each Carrier.

Will require a completed Limited Insurance Agreement when submitting cash with application. Please make sure ALL the dates are the same Financial Documentation:

✓ Certain DB amounts will warrant financial justification and/or a financial statement to be completed. ✓ Business as Owner, please include business financial statements to include Balance Sheets, Income Statements, and Cash Flow

Statements (if available) for at least the last two years. ✓ Please reference all Older Age and Premium Financing Requirements per individual carrier.

New Business Checklist:

PROCEDURES

9

Applications should include a cover letter. As not every case is straightforward, giving some forethought and explaining the nature and purpose of the sale to an underwriter makes what was not obvious, very clear—this can avoid complications and delays later in the process.

The following information should be included in a cover letter: ✓ Agent/Client relationship ✓ Purpose of Coverage ✓ Determination of Death Benefit & Premium Payment ✓ Other Insurance Coverage & Additional Information on the insured ✓ Premium Financing Details (if being utilized) ✓ Ownership Structure

Agent/Client relationship: How long have you known the client and what is the nature of your relationship. How did the sale arise?

Purpose of Coverage: Provide details of the purpose of the coverage, why is it needed?

Determination of Death Benefit & Premium Payment: Explain how the amount of coverage was determined; If any analyses was done, provide copies. How will the coverage be paid for? What is the source of funds? If the premium is more than 25% of the client’s income, detailed explanation will be needed.

Other Insurance Coverage & Additional Information on the insured: Is there any other insurance in force? If so, how much? If not, why is there coverage being purchased at this Juncture. Is the insured married? Is the spouse insurable? Is there anything in the client’s background that should be addressed on the front end? (liens, criminal record, recently settled policies – why?) Is the client applying for any other coverage; Has the client applied for or purchased any coverage recently?

Ownership Structure: If the coverage is trust owned, provide explanation of the purpose of the trust Who is the trustee? Who are the beneficiaries of the trust? What is their relationship to the insured?

The Cover Letter:

PROCEDURES

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PROCEDURES

Important Contact Information:

Department E-mail Address

Underwriting underwriting@vanbridge.com Formals amanda@vanbridge.com Compensation gligeon@vanbridge.com Annuities/Disability michael@vanbridge.com Illustrations/Products pete@vanbridge.com Advanced Planning mitch@vanbridge.com Licensing/Contracting contracting@vanbridge.com

These are the department contacts—your dedicated case manager or consultant may be different than the above.

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Name Male Female Social Security # Address City State Zip Date of Birth Age Height Weight Monthly Income Occupation Net Worth

Name Social Security # Phone Number Address City State Zip Email Address

Universal Life Variable Life Whole Life Term, Level Period Survivorship* (*Please have other insured complete a TAPP) Face Amount Desired Premium Amount Desired Annually Monthly Insurance Companies Requested — Please Include your Agent ID/Rep Code for each Insurance Company requested

Please include a complete HIPPA authorization form. If you are replacing coverage, will there be any 1035 money with this replacement Y / N If yes, what amount will be carried over? What is the purpose of this insurance?

Insurance Company Agent ID/Code

Company Policy/Application Date Amount Class/Rating Issued Current Premium Do you intend to replace?

Preliminary Inquiry—Not an application for life insurance. This TAPP form is used exclusively to gather specific information on a proposed insured’s medical history and other factors that may impact the underwriting and rating classification. This is not an application for insurance and in no way guarantees a specific underwriting class or binds any insurance coverage with any insurance carrier. Personal History — (this section must be completed)

Agent Information — (this section must be completed)

Requested Plan of Insurance — (this section must be completed)

All pages of the TAPP must be complete. Trial cannot be considered without an authorization form signed and initiated by Proposed Insured.

Page 1 of 5

TrialAPPlication

Who is your primary care physician?

When did you last consult him/her? Why? What other physicians have you consulted during the past five years? Why? (Do not include insurance examinations)

When did you last consult him/her? Why?

Phone Number Address City State Zip

Physicians Name Phone Number Address City State Zip

Physicians Name Phone Number Address City State Zip

Physicians Name Phone Number Address City State Zip

When did you last consult him/her? Why?

When did you last consult him/her? Why?

Proposed Insured: Social Security Number:

Medical History — (this section must be completed)

All pages of the TAPP must be complete. Trial cannot be considered without an authorization form signed and initiated by Proposed Insured.

Page 2 of 5

TrialAPPlication

Proposed Insured: Social Security Number:

In what hospitals, clinics, or other health facilities have you ever been treated? Date Illness

Please list all medications.

Have any immediate family members (parents, siblings) been diagnosed or died from heart disease or cancer? Y / N If yes, please provide the following details:

Relation (mother, father, brother, sister)

Diagnosis Approximate age of disease onset

(if deceased) age at death

Medical History — (this section must be completed)

Family History — (this section must be completed)

Are you a private pilot? Y / N if yes, provide details below. How many total hours have you flown as Pilot in Command? How many hours do you fly per year? Do you have an IFR (instrument flight rating)? Y / N Do you participate in the following activities? (circle those that apply)

Scuba Diving Bungee Jumping Ultra light Flying Sky Diving Mountain Climbing Hang Gliding Auto/Motorcycle Racing Other

Hazardous Activities — check here if this section is not applicable.

All pages of the TAPP must be complete. Trial cannot be considered without an authorization form signed and initiated by Proposed Insured.

Page 3 of 5

TrialAPPlication

Date of diagnosis of first chest pain: Number of diseased vessels: Dates/details of treatment/surgery (examples: Angioplasty, Bypass) Date of last stress EKG: Results: By whom? Any pain since treatment/surgery?

Exact name and location of cancer: Stage and grade: Who would have the pathology report? Dates/details of treatment/surgery:

Date of diagnosis: Treatment: (circle one) Diet Only Oral Medication Insulin Details: Do you regularly test your blood glucose? Y / N Results: Frequency: Latest result of glycohemoglobin (A1C) test: mg% Date: Have you EVER had: a. any eye trouble? Y / N d. kidney trouble? Y / N b. heart trouble? Y / N e. neuritis/neuralgia? Y / N c. high blood pressure? Y / N f. insulin reactions? Y / N

All pages of the TAPP must be complete. Trial cannot be considered without an authorization form signed and initiated by Proposed Insured.

Coronary — check here if this section is not applicable.

Cancer — check here if this section is not applicable.

Diabetes — check here if this section is not applicable.

Proposed Insured: Social Security Number:

Page 4 of 5

TrialAPPlication

Do you currently drink alcohol? Y / N Did you ever drink substantially more than present? Y / N Date of last consumption: If yes, when? Note amount below. Note amount below.

Have you ever consulted a doctor or received treatment because of your alcohol use? Y / N Have you ever been arrested for driving under the influence of alcohol? Y / N If yes, provide date(s): Have you ever used illegal drugs or sought treatment because of drug use? Y / N If yes, provide details: Types of drug(s) used: Date of last use: Doctor/Facility name and address:

Type: Amount per week:

Beer

Wine

Liquor

Type: Amount per week:

Beer

Wine

Liquor

Drug and Alcohol Usage Questionnaire —

Proposed Insured: Social Security Number:

Tobacco/Nicotine Usage Have you ever smoked cigarettes: Y / N If yes, date of last usage: Have you ever used other tobacco or nicotine containing products: Y / N (examples: cigars, pipe, snuff, nicotine gum, or patch) If yes, provide types and last date of use:

All pages of the TAPP must be complete. Trial cannot be considered without an authorization form signed and initiated by Proposed Insured.

Notes:

Page 5 of 5

TrialAPPlication

Authorization to Obtain and Disclose Confidential Information This form is HIPAA Compliant

Proposed Insured’s Name

Date of Birth Social Security Number Records and Information obtained from the Proposed Insured or other parties may be disclosed to and between the insurance companies or the insurance agencies listed below, Vanbridge Insurance Services, LLC, brokers, contractors, employees, representatives and agents working for or through for purposes of the Proposed Insured applying for or evaluating insurance coverage.

Insurers and Agencies Accordia AIG Allianz Life American General Life Insurance Co. American National Insurance Co. Americo Financial Life & Annuity Ameritas APPS Paramedical Aviva AXA Equitable Life Insurance Co. Banner Life Brighthouse Financial Brighthouse Life Insurance Company Brighthouse Life Insurance Company of NY Canada Life Assurance Co. of Insurance Columbus Life Insurance Crown Global EMSIExpress Imaging Services Fidelity & Guaranty Life Insurance Co. Fidelity Life Association General American Life Insurance Co. Genworth Life and Annuity Genworth Life Insurance Co. Great-West Life & Annuity Insurance Co. Guardian Life Indianapolis Life John Hancock Life & Health Insurance Co John Hancock Life Insurance Co. (U.S.A.) John Hancock Life Insurance Company of NY Kestra Investment Services, LLC Liberty Mutual Life of South West

Lincoln Benefit Lincoln Financial Companies Lincoln Life & Annuity Co. of New York Lincoln National Life Insurance Co. Lloyd's of London Lombard International Massachusetts Mutual MetLife MetLife Investors USA Insurance Co. Metropolitan Life Insurance Co. Minnesota Life Mutual of Omaha National Life of Vermont National Western Nationwide Life and Annuity Co. of America New England Life Insurance Co. New York Life Insurance and Annuity Co. New York Life Insurance Co. North American Co. Northwestern Mutual NYLIFE Insurance Co. of Arizona OneAmerica Ohio National Life Old Mutual Financial Network Pacific Life Pacific Life and Annuity Co. Penn Mutual Life Petersen International UW Portamedics Principal National Life Insurance Company Principal Life Insurance Company Protective Life & Annuity-NY Protective Life Insurance Co.

Protective of NY Pruco Life Insurance Co. Pruco Life Insurance Co. of New Jersey Prudential Life Insurance Companies ReliaStar Life Insurance Co. ReliaStar Life Insurance Co. of NY Savings Bank Life Insurance Company of MA Security Life of Denver Security Mutual Life Standard Life Sun Financial Sun Life Assurance Co. of Canada Sun Life Insurance and Annuity Co. of NY Sun Life Insurance Co. of America Symetra Life Insurance Company The Standard Transamerica Financial Life Transamerica Life Insurance Transamerica Life Insurance and Annuity Co. Union Central United of Omaha Unum United of Omaha US Life Insurance Co. VOYA Vanbridge LLCVanbridge Insurance Services, LLC Vanbridge Partners LLC Western Reserve Life William Penn of New York Zurich American Life Insurance Co

Additional Insurers and Agencies:

Any medical facility, health plan, health care professional, laboratory, other medical entity, insurance support organization, brokers, financial institution, consumer reporting agency and my employer, to give the information described above to the Insurers and Agencies listed afore and to:

Advisor Name:

Firm Name:

Send to: underwriting@vanbridge.com or mail to Vanbridge Insurance Services, LLC, 225 NE Mizner Blvd, Suite 675, Boca Raton, FL 33432

I understand that any Insurer or Agency named afore, its reinsurers, and insurance support organizations, and those persons authorized to represent them may need to collect such information for proposed insurance coverage. The Insurers and Agencies named afore and their reinsurers will use the information in order to determine whether I am insurable or to assist in the application and underwriting process. The insurance producer may also use this information to help update and improve my insurance program.

Revised 2017 THIS IS NOT AN APPLICATION FOR LIFE INSURANCE Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC

Authorization to Obtain and Disclose Confidential Information

This form is HIPAA Compliant The purpose of this Authorization is to assist in the evaluation and placement of my application for insurance. I hereby authorize the release of any and all records and information regarding me, the proposed insured, pursuant to this Authorization. This includes, without limitation, any and all records and protected health information regarding diagnosis, testing, treatment and prognosis of my physical or mental condition, with the exclusion of psychotherapy notes. Such records and information to be released may include, but are not limited to, facts about my: (1) mental and physical health; (2) alcohol/drug abuse treatment, (3) pharmacy prescriptions, (4) HIV testing and treatment, except where prohibited by law, (5) sexually transmitted diseases, (6) Sickle Cell testing and treatment, (7) laboratory test results, (8) other insurance coverage, (9) hazardous activities, (10) character, (11) general reputation, (12) mode of living, (13) finances, (14) occupation, and (15) other personal traits. Obtain and use non-health and non-medical information, including but not limited to financial information, credit reports, consumer reports, driving record, criminal record, character, general reputation, personal characteristics or behavioral and lifestyle factors and information about avocations and aviation activity; use all of this information to evaluate an application for insurance, a claim for insurance benefits, or both; use any information relating to communicable diseases and other risk factors relating to me or to my spouse or life partner to evaluate an application for insurance on either me or my spouse or life partner. I understand that any Insurer or Agency named afore, its reinsurers, and insurance support organizations, and those persons authorized to represent them may need to collect such information for proposed insurance coverage. The Insurers and Agencies named afore and their reinsurers will use the information in order to determine whether I am insurable or to assist in the application and underwriting process. The insurance producer may also use this information to help update and improve my insurance program. I hereby authorize any medical practitioner, including my primary care physician listed below, Physician Name

Physician Address

I (we) authorize Vanbridge Insurance Services, LLC to release and disclose the information described:

a. to its affiliates, insurers, reinsurers, persons or organization providing services relating to insurance underwriting, MIB and as otherwise required by law. b. to release and disclose the information to other duly licensed life insurers if I (we) have applied or apply to the other insurers for insurance. c. To insurers, reinsurers, to make a brief report of my personal health information to MIB. d. to the Life Insurance Representative(s) representing me to duly licensed specific life insurers for the purpose of applying for life insurance if my (our) application is declined or if unable to offer coverage at an acceptable rate. e. to the Life Insurance Representative(s) and its staff, affiliated companies and/or entities, insurance companies and their re-insurers representing me on my (our) application for insurance if it is necessary to provide an explanation of the reasons for a decision to impose special underwriting requirements, whenever my application cannot be approved as submitted, or in connection with a claim for benefits.

I understand that my information will be kept confidential, and will not be disclosed to other persons or organizations without this written permission for the purposes referenced herein, except to the extent that it is necessary for (1) the Insurers and Agencies named afore and their reinsurers and other entities required to conduct business; (2) other insurers to which I have applied or may apply; (3) reinsurers; or (4) other persons whom perform business, professional or insurance services for them. They may also disclose this information as allowed by law. I understand that the Agencies and Insurers listed afore may use secured internet-based systems to store/access some or all of the confidential and personal medical information.

I understand I do not have to sign this authorization in order to obtain benefits (treatment, payment or enrollment). I (we) understand that any information about me (us) that is disclosed pursuant to this authorization may be subject to re-disclosure and no longer covered by certain federal rules governing privacy and confidentiality of health information. The information contained in these medical and financial records will be held in confidence and may be used only for the purpose of the procurement, or underwriting for the possible procurement or the evaluation of life, health, long term care, or other insurance products. During the evaluation of my (our) insurance application, I (we) understand that I (we) have the right to revoke the authorizations in the previous sections (above) by writing to Vanbridge Insurance Services, LLC, 225 NE Mizner Blvd, Suite 675, Boca Raton, FL 33432. If this authorization is revoked, this would result in the file being closed and no coverage provided.

Revised 2017 THIS IS NOT AN APPLICATION FOR LIFE INSURANCE Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC

Authorization to Obtain and Disclose Confidential Information This form is HIPAA Compliant I (we) understand that my (our) personal information, including my (our) protected health information disclosed under this authorization will be incorporated into and made a part of any life and/or disability insurance policy(ies) issued by the Company and that the policy(ies) will be delivered to the policy owner. I acknowledge that any agreements I have made to restrict my protected health information do not apply to this authorization and I instruct any physician, health care professional, hospital, clinic, medical facility, or other health care provider to release and disclose my entire medical record without restriction. Any modifications to this authorization may preclude Vanbridge Insurance Services, LLC ability to process this application.

I understand that when information is used or disclosed pursuant to this Authorization, it may be subject to re-disclosure by the insurance company and may no longer be protected by the federal and state laws and regulations that may have applied in the first instance. This Authorization will remain in effect for 36 months from the date of my signature below. A photocopy and or email of this Authorization is as valid as an original. I acknowledge that I have received a copy of this Authorization and the Notice to Proposed Insured(s). If minor children are proposed for coverage, the above statements are made by the person authorized to act on their behalf.

Signature of Authorized Party

Signed at this day of year

Signature of Proposed Insured / Guardian or Custodian / Authorized Representative

X

Complete if Minor Child is Proposed for Coverage:

Name of Child: Relationship of Representative to Minor:

Signature of Witness: Signature of Policy Owner (s)

(not required)

Revised 2017 THIS IS NOT AN APPLICATION FOR LIFE INSURANCE Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC

Authorization to Obtain and Disclose Confidential Information

NOTICE TO PROPOSED INSURED

This notice must be given to the proposed insured before or at the time of signature.

Fair Credit Reporting Act Notice

Federal law requires that you be advised that in connection with your application or informal inquiry concerning insurance an investigative consumer report may be prepared whereby information is obtained through personal interviews with your family, friends, neighbors, business associates, financial sources, or others with whom you are acquainted. This report would include information as to your character, general reputation; personal characteristics and mode of living, except as may be related directly or indirectly to your sexual orientation. If you make a written request to any of the insurers named on the reverse side within a reasonable time after receipt of this notice, you will be informed whether or not an investigative consumer report was requested, and if such a report was requested, you will be advised of the name and address of the consumer reporting agency to whom the request was made. The consumer reporting agency, upon request, will furnish information as the nature and scope of its investigation. You have the right to inspect and to receive a copy of any such report by contacting the consumer reporting agency.

The Medical Information Bureau (MIB)

A source of information and medical records, MIB is a non-profit insurance support corporation which operates an information exchange on behalf of member life insurance companies. Member companies will ask the MIB if it has a record concerning you. If you previously applied to a member company for insurance, MIB may have information about you in its file. The purpose of the MIB is to protect member companies and their policy owners from those who would conceal significant facts relevant to their insurability. The information which is obtained from MIB may be used only as an alert to the possible need for further independent investigation. It cannot be used as a basis in making a final underwriting decision.

At your request, the MIB will arrange disclosure of any information it may have about you in its file. If you question the accuracy of information on file, you may contact the MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Re-porting Act. The address of the information office of MIB, Inc. is PO Box 105, Essex Station, Boston Massachusetts 02112, telephone number: 612.426.3660.

Notice of Insurance Information Practices

In the course of properly underwriting and administering your insurance coverage, the insurers named on the reverse side will rely primarily on information provided by you. They may also seek information from others, such as medical professionals who have treated you. In some cases, they may ask a consumer reporting agency to collect information and submit an investigative consumer report to them. This also authorizes the preparation of an investigative consumer report. You have the right to request to be interviewed in connection with the preparation of that report. The consumer reporting agency will make the contents of that report available to you in accordance with federal law.

In some situations, and in compliance with applicable law, the consumer reporting agency may disclose necessary items of information to the parties without your specific authorization.

You have the right to be told about, and to see and copy if you wish, items of personal information about you that appears in their files, including information contained in investigative consumer reports. You also have the right to seek correction of information you believe to be inaccurate.

THE ABOVE IS A GENERAL DESCRIPTION OF THE NAMED INSURERS AND YOUR AGENT’S INFORMATION

PRACTICES. EACH INSURER NAMED HEREIN REQUIRED THE COMPLETION OF A FULL APPLICATION OF ITS RESPECTIVE PRODUCT LINES.

Revised 2017 THIS IS NOT AN APPLICATION FOR LIFE INSURANCE Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC

For First Time Users: Go to the Vanbridge Insurance Services website at www.vbiservices.com.

Click on the Login button on the top right of the landing page.

If you have not previously registered, click on the word Register to the left of the LOGIN button, fill out the required fields and Submit Request.

Requests for access are usually approved within 24 hours; you will be notified by email when your registration is approved.

You will choose your own username and password.

If you forget your username and/or password, click on the “Forgot? ” Link and provide your username or the email address you registered with.

If you need technical assistance please use our Live Chat feature, M-F 9am-5pm or email contactus@vanbridge.com

For Online Contracting: Go to the Vanbridge Insurance Services website at www.vbiservices.com.

Once you are logged in, hover over the Underwriting and New Business tab and click on Licensing, Contracting + Compensation from the drop down. Select Get Contracted to access and click on the link. Select New User to begin the process. It will take you through a series of questions that includes everything needed to complete carrier contracting forms. The initial process takes 10-15 minutes to set up your profile. Your information is then saved for all of your future appointment requests with Vanbridge Insurance Services.

For Case Control: Go to the Vanbridge Insurance Services website at www.vbiservices.com.

Hover over the Underwriting and New Business tab, scroll down and click on Case Control (Pending Business).

You will need to register for a Pipepass login in order to use the new DataView system. Some of you may already have Pipepass login credentials (it’s what you needed to register for to access some of our E-Apps). Others will need to sign up for a new ID which you can do right on the login screen.

Please review the attached detailed documentation that will walk you through how to register and provides screenshots of the dashboard, search function, case details and case notes. If you have any questions or need additional information, please contact

contracting@vanbridge.com for help.

For WinFlex Web: Go to winflexweb.com or Go to the Vanbridge Insurance Services website at www.vbiservices.com and hover over the Resources tab,

and from the drop down select WinFlex Web.

Register as a new user. (user name = email address; create unique password).

NOTE: Each user profile is driven by a unique email address. If an account already exists with that email, then a different one will be needed.

Enter BGA Office: Vanbridge Insurance Services Click “Continue Registration”

Please note…There is a link that is sent to Vanbridge to verify/authorize new user. Once this is approved, the registering agent will receive an email notifying them their WinFlex Web access is active.

WEBSITE TOOLS | Getting Started

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NAME DEPARTMENT TITLE EMAIL DIRECT PHONE DIRECT FAX

MITCHELL SMITH MANAGEMENT MANAGING PRINCIPAL MITCH@VANBRIDGE.COM (800) 878-8280 (866) 477-6480

KRISTIN JENKINS SENIOR EXECUTIVE ASSISTANT | COMPLIANCE OFFICER KRISTIN@VANBRIDGE.COM (954) 670-5188 (877) 305-5243

VINCE JENKINS SALES PRINCIPAL, CORPORATE AND INSTITUTIONAL INSURANCE VINCE@VANBRIDGE.COM (215) 498-9489

JAMIE LORENTZ SALES AVP, CORPORATE AND INSTITUTIONAL INSURANCE JAMIE@VANBRIDGE.COM (260) 241-7444

ADAM SPRING SALES PRINCIPAL ASPRING@VANBRIDGE.COM (954) 418-7305 (877) 907-9681

RYAN PERNA SALES PRINCIPAL RPERNA@VANBRIDGE.COM (954) 418-7303 (877) 907-9680

BLAKE MALLONEE SALES BUSINESS DEVELOPMENT & DISTRIBUTION BLAKE@VANBRIDGE.COM (954) 249-4999

JULIE F. SMITH MARKETING SVP, DIRECTOR OF MARKETING JSMITH@VANBRIDGE.COM (954) 418-7308 (877) 830-1909

GENE LIGEON ACCOUNTING COMMISSIONS GLIGEON@VANBRIDGE.COM (954) 418-7311

PETE DRESSLER SALES/ILLUSTRATION SVP, DIRECTOR OF PRODUCT & ILLUSTRATIONS PETE@VANBRIDGE.COM (954) 670-5196 (866) 205-6639

MICHAEL CASTANEDA SALES/ILLUSTRATION PRODUCT AND CASE DESIGN SPECIALIST | DI & ANNUITIES MICHAEL@VANBRIDGE.COM (512) 751-7688

ERICA CHIRAS INFORMAL/UW UNDERWRITER VBI-UNDERWRITING@VANBRIDGE.COM (954) 703-8528 (866) 208-9486

STACY SORENSEN INFORMAL/UW UNDERWRITER VBI-UNDERWRITING@VANBRIDGE.COM (954) 418-7310 (866) 208-9486

JESSICA SCHMIDT LICENSING & CONTRACTING DIRECTOR OF LICENSING AND CONTRACTING VBI-CONTRACTING@VANBRIDGE.COM (954) 418-7314 (954) 903-4664

AMANDA POGRELL NEW BUSINESS SVP, DIRECTOR OFADVANCED NEW BUSINESS AMANDA@VANBRIDGE.COM (954) 363-7250 (877) 325-6426

PRISCILLA HAZAN NEW BUSINESS CASE MANAGER PRISCILLA@VANBRIDGE.COM (954) 670-5194 (866) 205-6628

MARCELO NASCIMENTO NEW BUSINESS CASE MANAGER MARCELO@VANBRIDGE.COM (954) 670-5181 (866) 207-1609

BONNIE LANDI ADMIN ADMINISTRATIVE ASSISTANT BONNIE@VANBRIDGE.COM (954) 670-0888 (866) 208-5158

225 N.E. Mizner Boulevard, Suite 675

Boca Raton, FL 33432

800.878.8280

www.vbiservices.com

Primary Internal Staff Contact List