Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product commission schedules issued to the date of execution hereof by the respective Insurer. Name: Name: Transamerica Capital Inc State of Domicile: Business Address: 0000 Xxxxxxxx Xx XX Business Address: Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Dealer above) Contact Person at Broker Dealer: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ Corporation ¨ Partnership ¨ Other: Contact person for client policy and licensing matters (if different from above): Mail address for client policy and licensing matters: Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions matters (if different from above): Mail address for commission statements and checks: Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance matters (if different from above): Mail address for Legal and Compliance matters: Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Samples: Life Insurance Company Product Sales Agreement (Separate Account VA EE)
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product Product’s commission schedules issued to the date of execution hereof by the respective Insurer. Name: State of Domicile: Transamerica Financial Life Insurance Company Iowa Name: Business Address: Transamerica Capital Inc State of Domicile: 0000 Xxxxxxxx Xx XX Xxxxx Xxxxxx, XX 00000 Business Address: 0000 Xxxxxxxx Xx XX Business Address: Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Broker-Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Broker-Dealer above) Contact Person at Broker Broker-Dealer: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ ☐ Corporation ¨ ☐ Partnership ¨ ☐ Other: Contact person for client policy and licensing matters (if different from above): Mail Broker Dealer/Agency General Counsel: Mailing address for client policy and licensing mattersGeneral Counsel: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Broker Dealer/Agency Chief Compliance Officer: Mailing address for Chief Compliance Officer: Name: Phone: Fax: Main Office? Y or N (if yes, please list address here) Email: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions client policy and licensing matters (if different from aboveabove or indicate “Same”): Mail Mailing address for commission statements client policy and checkslicensing matters: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance commissions matters (if different from aboveabove or indicate “Same”): Mail Mailing address for Legal commission statements and Compliance matterschecks: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Samples: Selling Agreement (Transamerica Financial Life Insurance Co)
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product Product’s commission schedules issued to the date of execution hereof by the respective Insurer. Name: State of Domicile: Transamerica Life Insurance Company Iowa Name: Business Address: Transamerica Capital Inc State of Domicile: 0000 Xxxxxxxx Xx XX Business Address: 0000 Xxxxxxxx Xx XX Business Address: Xxxxx Xxxxxx, XX 00000 Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Broker-Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Broker-Dealer above) Contact Person at Broker Broker-Dealer: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ ☐ Corporation ¨ ☐ Partnership ¨ ☐ Other: Contact person for client policy and licensing matters (if different from above): Mail Broker Dealer/Agency General Counsel: Mailing address for client policy and licensing mattersGeneral Counsel: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Broker Dealer/Agency Chief Compliance Officer: Mailing address for Chief Compliance Officer: Name: Phone: Fax: Main Office? Y or N (if yes, please list address here) Email: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions client policy and licensing matters Mailing address for client policy and licensing matters: (if different from aboveabove or indicate “Same”): Mail address for commission statements and checks: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal commissions matters Mailing address for commission statements and Compliance matters checks: (if different from aboveabove or indicate “Same”): Mail address for Legal and Compliance matters: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product Product’s commission schedules issued to the date of execution hereof by the respective Insurer. Name: Name: Transamerica Capital Inc Capital, Inc. State of Domicile: Business Address: 0000 Xxxxxxxx Xx XX Business Address: Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Broker-Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Broker-Dealer above) Contact Person at Broker Broker-Dealer: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: ¨ Corporation ¨ Partnership ¨ Other: Contact person for client policy and licensing matters (if different from above): Mail Broker Dealer/Agency General Counsel: Mailing address for client policy and licensing mattersGeneral Counsel: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Broker Dealer/Agency Chief Compliance Officer: Mailing address for Chief Compliance Officer: Name: Phone: Fax: Main Office? Y or N (if yes, please list address here) Email: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions client policy and licensing matters (if different from aboveabove or indicate “Same”): Mail Mailing address for commission statements client policy and checkslicensing matters: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance commissions matters (if different from aboveabove or indicate “Same”): Mail Mailing address for Legal commission statements and Compliance matterschecks: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Samples: Broker/Dealer Sales Agreement (Separate Account Va M)
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product Product’s commission schedules issued to the date of execution hereof by the respective Insurer. Name: Transamerica Life Insurance Company Name: Transamerica Capital Inc Capital, Inc. State of Domicile: Iowa Business Address: 0000 Xxxxxxxx Xx XX Business Address: 0000 Xxxxxxxx Xx XX Xxxxx Xxxxxx, XX 00000 Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Broker-Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Broker-Dealer above) Contact Person at Broker Broker-Dealer: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ q Corporation ¨ q Partnership ¨ q Other: Contact person for client policy and licensing matters (if different from above): Mail Broker Dealer/Agency General Counsel: Mailing address for client policy and licensing mattersGeneral Counsel: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Broker Dealer/Agency Chief Compliance Officer: Mailing address for Chief Compliance Officer: Name: Phone: Fax: Main Office? Y or N (if yes, please list address here) Email: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions client policy and licensing matters (if different from aboveabove or indicate “Same”): Mail Mailing address for commission statements client policy and checkslicensing matters: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance commissions matters (if different from aboveabove or indicate “Same”): Mail Mailing address for Legal commission statements and Compliance matterschecks: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product Product’s commission schedules issued to the date of execution hereof by the respective Insurer. Name: Transamerica Life Insurance Company Name: Transamerica Capital Inc State of Domicile: Iowa Business Address: 0000 Xxxxxxxx Xx XX Business Address: 0000 Xxxxxxxx Xx XX Xxxxx Xxxxxx, XX 00000 Xxxxx Xxxxxx, XX 00000 Name: Transamerica Financial Life Insurance Company State of Domicile: New York Business Address: 0000 Xxxxxxxx Xx XX Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Broker-Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Broker-Dealer above) Contact Person at Broker Broker-Dealer: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mailEmail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ q Corporation ¨ q Partnership ¨ q Other: Contact person for client policy and licensing matters (if different from above): Mail Broker Dealer/Agency General Counsel: Mailing address for client policy and licensing mattersGeneral Counsel: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Broker Dealer/Agency Chief Compliance Officer: Mailing address for Chief Compliance Officer: Name: Phone: Fax: Main Office? Y or N (if yes, please list address here) Email: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions client policy and licensing matters (if different from aboveabove or indicate “Same”): Mail Mailing address for commission statements client policy and checkslicensing matters: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance commissions matters (if different from aboveabove or indicate “Same”): Mail Mailing address for Legal commission statements and Compliance matterschecks: Name: Phone: Fax: Main officeOffice? Y or N (if yes, please list address here) E-mailEmail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Samples: Broker/Dealer Sales Agreement (Separate Account Va Bny)
Insurers and Underwriters. The following affiliated Insurers and Underwriters are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products issued or underwritten by such parties, including each product commission schedules issued to the date of execution hereof by the respective Insurer. Name: Name: Transamerica Capital Inc State of Domicile: Business Address: 0000 Xxxxxxxx Xx XX Business Address: Xxxxx Xxxxxx, XX 00000 The following affiliated Broker Dealers and Agencies are deemed to be parties to, and bound by all provisions of, the Agreement with respect to Products distributed by such parties: (Print name of Broker Dealer above) Contact Person at Broker Dealer: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: (Print name of Agency above) Contact Person at Agency: Address: Name: Phone: Fax: Tax ID #: E-mail: ¨ Corporation ¨ Partnership ¨ Other: Contact person for client policy and licensing matters (if different from above): Mail address for client policy and licensing matters: (if different from above): Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for commissions matters (if different from above): Mail address for commission statements and checks: (if different from above): Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses) Contact person for Legal and Compliance matters (if different from above): Mail address for Legal and Compliance matters: (if different from above): Name: Phone: Fax: Main office? Y or N (if yes, please list address here) E-mail: Branch? Y or N (if yes, enclose list of branch addresses)
Appears in 1 contract
Samples: Life Insurance Company Product Sales Agreement (Separate Account VA PP)