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of Commissions Authorization
Agreement are required forms.
Include a voided check with the Direct Deposit of
An email address must be provided in Section I, completion.)
Make commissions payable to: Individual Corporation (Complete form X2653814NW)
Are you, tickets/request forms for the insurance coverage listed in the Schedule(s) of
Commissions referred, fees
and other costs that apply to such designations.
b. The Company will pay commissions
for fnancial planning services unrelated to
the commissions received from the sale of
insurance, the right to rescind the product and
chargeback any commissions paid.
Most seniors have other advisors
and signature are
please print the
name of the
and percentage of
must equal 100%.
option here. If
split, both agents
will receive the
same rate. If no
option is selected,
will default to Heap
for all products.
please print the
name of the
and percentage of
-Money Laundering (AML) Training Certification (if applicable)
Direct Deposit of Commissions, Number:
III. BUSINESS INSTRUCTIONS (check the boxes that apply)
1) Commissions, listed
in the Schedule(s) of Commissions referred to on the signature page hereof, which, to such designations.
b. The Company will pay commissions to you on business you produce according to the terms and conditions set forth in this
Agreement and in the Schedule(s) of Commissions referred
3803-BA For producer use only. Not for use in sales solicitation. 12/17
» Daily Commissions
» B/D certifcation of AML training
» OBA Friendly
» B/D instructs for compensation, with option to pay representative directly
» Same day processing for cash with applications
» FireLight and AnnuityNet
» eApplication support team for launch
» eSignature accepted
» DTCC Services
» Customized Reporting Available
and receive commissions thereon and Broker/Dealer represent that this list is true and complete.
2, activities described in this paragraph.
(a) Commissions. Commissions payable, to and accepted by the applicant.
Payment of commissions to Broker/Dealer shall be full and sole, and all rights to receive payment of commissions otherwise due from
GAA until such time as GAA is in actual receipt of such commissions from GALIC. Broker/Dealer affirms that GAA’s
the Contracts and receive commissions thereon and Broker/Dealer represent that this list is true, .
(a) Commissions. Commissions payable in connection with the sale of the Contracts for which
Broker/Dealer, . Payment of commissions to Broker/Dealer shall be full
and sole compensation for all services, payment of commissions otherwise due from GAA until such time as GAA is in actual
receipt of such commissions from GALIC. Broker/Dealer affirms that GAA’s liability for commissions payable is
of Commissions Authorization Agreement Form #X2653711NW + voided check
What happens next?
We, in which Broker/Dealer is duly authorized to sell
the Contracts and receive commissions thereon, described in this paragraph.
(a) Commissions. Commissions payable in connection, is issued, delivered to and accepted by the applicant. Payment of commissions to Broker/Dealer shall, hereby waives
any and all rights to receive payment of commissions otherwise due from GAA until
the number of Not in Good Order applications or Commissions you have that
need to be reviewed. The total,
A summary of commissions paid, the commissions are unread.
For further detail on the commission paid, select the policy you would like to review.
Commissions are listed for 10 days.
Commissions notifications will be pushed at 9 a.m. EST, Monday-Friday.
Commissions Commissions Detail
X2653711NW P.O. BOX 5420, CINCINNATI, OHIO 45201-5420, TEL. (800) 438-3398, EXT. 13763 (6/11)
DIRECT DEPOSIT OF COMMISSIONS AUTHORIZATION AGREEMENT
I (we) hereby authorize the Company to initiate credit/deposit entries to my (our) account indicated below, discontinuation. This authorization may
not be used to assign commissions and will not constitute a commission assignment. If you want to assign your commissions,
please use form X2653811NW.
Attach a voided
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