LS-0316 ST 10/08 LifeSecure Insurance Company – Brighton, MI Policy Series LS-0002

LifeSecure Agent Appointment

For Agent Use Only. Not For Solicitation Purposes

Step 1 Agent QUICK Appointment Quick Appointment Process

One page Appointment Process with proof

of LTC CE at the time of Quick Appointment

Agent 6-digit writing number & access to

Agent Portal

180 days to submit 1st LTC application

Upon submission, full agent appointment

package is required

Agent commissions may be delayed if full

appointment paperwork is not received in a

timely manner

Quick appointment is not available in the

following state(s): NM & PA. Also not

available when submitting a Worksite or

Group/Association case

For Agent Use Only. Not For Solicitation Purposes

Step 2 Agent FULL Appointment

Agent Appointment Checklist

LifeSecure Agent Appointment Application

Commission Schedule “Exhibit 3”

Distribution Partner Hierarchy Form

LifeSecure Selling Agreement

ACH w/void check or deposit slip

Personal IRS W-9 Form

Assignment of Commissions Form, if

applicable

Copy of ACTIVE insurance license(s)

Copy of LTC CE training & partnership

training, according to state regulations

For Agent Use Only. Not For Solicitation Purposes

Agent Appointment Application – Page 1

Agent Appointment Application

This is a 5 page document

There are questions requiring your response on pages 1, 2, 3 & 5

Here on page 1 your MGA/Distribution Partner may pre-fill their information

For Agent Use Only. Not For Solicitation Purposes

Agent Appointment Application – Page 2

Agent Appointment Application

On page 2 please be sure to complete the “Licensing Information” section

You may be appointed in up to 3 states at initial appointment

Copies of ACTIVE insurance licenses are required for each state

New states may be added with the submission of business and a copy of an active insurance license in that state, plus the state required LTC CE training/ partnership training

For Agent Use Only. Not For Solicitation Purposes

Agent Appointment Application – Page 3

Agent Appointment Application

On page 3 please be sure to complete the “General Information” section

For Agent Use Only. Not For Solicitation Purposes

Agent Appointment Application – Page 5

Agent Appointment Checklist

Page 5 requires the agent’s signature

For Agent Use Only. Not For Solicitation Purposes

Agent Commission Schedule

Agent Commission Schedule

Provides selling agent commission information

Please note: the different commission levels based upon applicant age, premium payment method and client type – Individual vs. Multi-Life clients

States can have specific guidelines

For Agent Use Only. Not For Solicitation Purposes

Distribution Partner Hierarchy Form

Distribution Partner Hierarchy

Provides Distribution Partner organization hierarchy information

This form and information is provided by your distribution partner and is used to place you (the writing agent) within the organization hierarchy

For Agent Use Only. Not For Solicitation Purposes

LifeSecure Agent Selling Agreement – Page 1

LifeSecure Selling Agreement

The selling agreement is 13 pages in length. The selling agreement outlines the obligations and responsibilities of both the agent and LifeSecure

Agents must provide information on pages 1 and 8

Here on page 1 agents must provide their personal information, not agency information

For Agent Use Only. Not For Solicitation Purposes

LifeSecure Agent Selling Agreement – Page 8

Agent Selling Agreement

Page 8 requires the agent’s signature

For Agent Use Only. Not For Solicitation Purposes

ACH – Direct Deposit Form

ACH – Direct Deposit Form

LifeSecure pays ALL commissions via electronic fund transfer (EFT)

Please attach a copy of a void check or bank account deposit slip. This is only used to verify routing and account numbers

For Agent Use Only. Not For Solicitation Purposes

W-9 Form

W-9 FORM

The W-9 form is 3 pages in length and requires responses on pages 1 & 3

The W-9 form must be completed by ALL agents, including those agents requesting assignment of their commissions, but remain eligible for the LifeSecure Rewards Program and contests!

For Agent Use Only. Not For Solicitation Purposes

Assignment of Commissions Form

Assignment of Commissions

The “Assignment of Commissions” form is required only when an agent is requesting to assign their commissions to another person or entity.

The “Assignor” is the Agent and the “Assignee” is the person or entity the agent is assigning their commissions to.

For Agent Use Only. Not For Solicitation Purposes

LifeSecure Appointment Process Review!

QUICK

Agent Appointment Process

One page Appointment Process with

proof of LTC CE at the time of Quick

Appointment

Agent 6-digit writing number & access to

Agent Portal within 48 hours

180 days to submit 1st LTC application

Upon submission, a full agent

appointment package is required

Commissions may be delayed if full

appointment paperwork is not received

Quick appointment is not available in the

following state(s): NM & PA

FULL

Agent Appointment Checklist

LifeSecure Agent Appointment Application

Commission Schedule “Exhibit 3”

Distribution Partner Hierarchy Form

LifeSecure Selling Agreement

ACH w/void check or deposit slip

Personal IRS W-9 Form

Assignment of Commissions Form, if

applicable

Copy of ACTIVE insurance license(s)

Copy of LTC CE training/Partnership training,

as required by state

For Agent Use Only. Not For Solicitation Purposes

LifeSecure Agent Compliance Manual

For Agent Use Only. Not For Solicitation Purposes

Questions?

Please contact your Agent Support

Call Center between the hours of

8:30 AM and 6:00 PM (EST)

Toll free: (866) 582-7701

OR (810) 220-8770

For Agent Use Only. Not For Solicitation Purposes