Common use of AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT Clause in Contracts

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME AGENCY # ADDRESS CHECKING ACCOUNT # 9 DIGIT ROUTING # CREDIT UNION % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “DEPOSIT ADVICE” form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only American National Life Insurance Company of Texas Authorization American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant’s manager or agency, or which may have been written off. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME SSN # AGENCY # DEPOSITORY (BANK) NAME ADDRESS CITY, STATE, ZIP / / CHECKING ACCOUNT # SAVINGS ACCOUNT # 9 DIGIT ROUTING # 9 DIGIT ROUTING # CREDIT UNION MONEY MARKET ACCT. % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “"DEPOSIT ADVICE” " form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only American National Life Insurance Company of Texas Authorization American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant’s manager or agency, or which may have been written off. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.Only

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME AGENCY # ADDRESS CHECKING ACCOUNT # 9 DIGIT ROUTING # CREDIT UNION % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “DEPOSIT ADVICE” form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only American National Life Insurance Company of Texas Authorization American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant’s manager or agency, or which may have been written off. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Broker II Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* page 1 of 5 American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT BROKER II (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME SSN # AGENCY # DEPOSITORY (BANK) NAME ADDRESS CITY, STATE, ZIP / / CHECKING ACCOUNT # SAVINGS ACCOUNT # 9 DIGIT ROUTING # 9 DIGIT ROUTING # CREDIT UNION MONEY MARKET ACCT. % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “"DEPOSIT ADVICE” " form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only Form 4589 Rev. 01/09 Producer’s Code of Conduct As a representative of the American National Life family of companies I recognize my responsibility to: Conduct myself in the highest character with honesty, integrity, and fairness at all times. Provide information to clients in a professional manner which is honest, relevant, and designed to meet the client’s needs. Understand and accurately represent the Company’s products and services. Ensure my personal interests do not conflict with those of clients or the Company. Render prompt and quality service both before and after the sale to clients and their beneficiaries. Learn and follow all Company policies and procedures related to my role as a producer. Keep informed with respect to applicable laws and regulations and to observe them in the practice of my profession. Not replace a life or health insurance or a financial product of a client unless it is in their best interest. Xxxxxx good will, courtesy, and consideration in the treatment of policyowners and the general public, while maintaining respect for the Company. Meet all continuing education requirements. Endorse and support the Insurance Marketplace Standards Association’s (IMSA’s) Principles of Ethical Market Conduct. • Conduct business according to high standards of honesty and fairness and to render that service to its customers which, in the same circumstances, it would demand for itself.; • Provide competent and customer-focused sales and service; • Engage in active and fair competition • Provide advertising and sales materials that are clear as to purpose and honest and fair as to content; • Provide for fair and expeditious handling of customer complaints and disputes; • Maintain a system of supervision and review that is reasonably designed to achieve compliance with these Principles of Ethical Market Conduct. Form 4516 *4516* Rev 7-99 American National Insurance Company of Texas Authorization American National Life Insurance Company of Texas One Xxxxx Plaza(ANICO) Independent Marketing Group (IMG) IMG Web Site: xxx.xxx.xxxxxxxx.xxx ANTI-MONEY LAUNDERING COMPLIANCE (AML) Effective May, Galveston2006, TX 00000ANICO implemented an AML program to comply with federal anti-0000 Phone Number: money laundering regulations for insurance companies. The regulations apply to all individual life insurance and annuities (000) 000-0000 Mailing Address: PO Box 1795 Galvestonincludes individually sold group products), TX 77550-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Actindividual registered life insurance and annuities, as amended, provides that any consumer reporting agency may furnish and group registered variable annuities. As a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to giveresult, in writingorder to obtain an appointment with ANICO, orally, or in any other form, all producers are required to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on provide proof that they have completed basic AML training within the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which last 12 months that is used or expected acceptable to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loansANICO, and debts, including, but not limited to, any indebtedness that may have been charged they are required to the Applicantcomplete ANICO’s manager or agency, or which may have been written offCompany-Specific training course. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas Producers will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like be required to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right periodic AML training in order to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to itmaintain their appointment.

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME SSN # AGENCY # DEPOSITORY (BANK) NAME ADDRESS CITY, STATE, ZIP / / CHECKING ACCOUNT # SAVINGS ACCOUNT # 9 DIGIT ROUTING # 9 DIGIT ROUTING # CREDIT UNION MONEY MARKET ACCT. % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “"DEPOSIT ADVICE” " form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only Form 4589 Rev. 01/09 NOTICE OF PRIVACY POLICY American National Life Insurance Company of One Xxxxx Plaza Galveston, Texas Authorization 77550 American National Life Insurance Company of Texas One Xxxxx Plazais committed to providing insurance and annuity products and services designed to meet your needs. We are equally committed to respecting your privacy and protecting the information about you that we may receive. We have prepared this notice to advise you what information we collect, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom how we use it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant’s manager or agency, or which may have been written off. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to how we protect it.

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT. I authorize American National Life Insurance Company of Texas and the bank listed to deposit my commissions to the account name below. This authority will remain in effect until I provide a new authorization or cancellation. The company reserves the right to initiate debit entries for recovery of sums due to credit entries processed in error, if determined within the week of the credit entry. A Voided Check must be submitted with your request for Direct Deposit. AGENT NAME SSN # AGENCY # DEPOSITORY (BANK) NAME ADDRESS CITY, STATE, ZIP / / CHECKING ACCOUNT # SAVINGS ACCOUNT # 9 DIGIT ROUTING # 9 DIGIT ROUTING # CREDIT UNION MONEY MARKET ACCT. % TO CHECKING ACCT. SSN # DEPOSITORY (BANK) NAME CITY, STATE, ZIP SAVINGS ACCOUNT # 9 DIGIT ROUTING # MONEY MARKET ACCT. % TO SAVING ACCT. (Name as it appears on checking account) (Name as it appears on savings account) If contract file is submitted electronically through nomoreforms, a voided check should be scanned and submitted as an attachment to the file or you may fax a copy to 0-000-000-0000. If submitting voided check by fax, please include a cover sheet indicating original file was submitted through nomoreforms and list applicant’s name. EFT PROCEDURES Once you have signed up, your check will be automatically deposited into your checking and/or savings account approximately 3-4 weeks from the day the Home Office received the request. You will receive a “"DEPOSIT ADVICE” " form which will replace your check stub. This form will show your gross and net pay for the month and year-to-date. It will also show other deductions. For Agent Use Only American National Form 4589 Rev. 01/09 AMERICAN NATIONAL INSURANCE COMPANY GENERAL AGENT COMPENSATION SCHEDULE Life Insurance Company Products Ages 1st Year Target Premium Yr. 2 - 3 Yr. 4 - 5 Additional Deposits/Renewals Yr. Yr. 6 - 7 8 - 10 Yr. 11+ 1 This compensation schedule shall cancel and supersede all previously effective Compensation Schedules and Paid Production requirements, but it shall not impair your rights to commissions or fees, if any, earned under the provisions of Texas Authorization American National any prior schedules. Commissions and fees are expressed as a percentage of premiums paid unless otherwise noted. Schedule consists of 5 pages total. ANICO Indexed UL2 18-69 80 2 2 2 2 0.6 excess 18-69 2 2 2 2 2 0.6 70-85 75 2 2 2 2 0.6 excess 70-85 2 2 2 2 2 0.6 ANICO Executive UL2 0-69 80 2 2 2 2 2 excess 0-69 2 2 2 2 2 2 70-85 75 2 2 2 2 2 excess 70-85 2 2 2 2 2 2 Affinity 7 Par Whole Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 000000-0000 Phone Number: 69 80 2 2 2 2 0.7 70-79 60 2 2 2 2 0.7 80-85 30 2 2 2 2 0.7 ANICO Signature Term (000Annual policy fee is non-commissionable) 000ART 18-0000 Mailing Address: PO Box 1795 Galveston, TX 7755065 80 - - - - - 10 year term 3 18-1795 *AUTH* REQUIRED BY THE FAIR CREDIT REPORTING ACT The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance 70 80 - - - - - 15 year term 18-65 85 - - - - - 20 year term 18-60 90 - - - - - 30 year term 18-50 90 - - - - - Commissions on riders originally issued with the written instructions policy are paid at the same rates as the base policy unless otherwise shown, except for the Level Term Rider on ANICO Executive UL. Any additional premium paid because of this rider will be commissioned at the policy's rate for excess premium. Commissions for policy increases and riders added after the policy is issued are paid at the same first year and renewal rates as the policy for the amount of the consumer increase unless otherwise shown. Commissions on increases and on riders added after the policy is issued will be paid to whom it relates. In accordance with that provision, the person signing this form as “Applicant” hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on agent who writes and submits the Applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part application for the purpose of serving as a factor in establishing the Applicant’s eligibility for credit, employment increase or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Life Insurance Company of Texas may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant’s character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Life Insurance Company of Texas or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant’s production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant’s manager or agency, or which may have been written off. The Applicant authorizes American National Life Insurance Company of Texas or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Life Insurance Company of Texas will make an offer of a contract to the Applicant. l For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. Applicant’s Printed Name Applicant’s Signature Date Social Security Number American National Life Insurance Company of Texas General Agent’s Agreement American National Life Insurance Company of Texas One Xxxxx Plaza, Galveston, TX 00000-0000 Phone Number: (000) 000-0000 Mailing Address: PO Box 1795 Galveston, TX 77550-1795 *CON* American National Life Insurance Company of Texas (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to itaddition.