New Business Applications Sample Clauses

New Business Applications. To help expedite new business applications submitted simultaneously with agent appointment paperwork, please include the following information and return with your appointment paperwork. Agent Name Client Name Date new business application was signed State in which the application was signed State in which the client resides

New Business Applications. To help expedite new business applications submitted simultaneously with agent appointment paperwork, please include the following information and return with your appointment paperwork: Agent Name Client Name Date new business application was signed State in which the application was signed State in which the client resides Type of business written The following states require an appointment at the time of solicitation:  Alabama  Kansas  Kentucky  Louisiana  Missouri  Montana  Ohio  Pennsylvania  Puerto Rico  Texas  Vermont  Washington  Wisconsin If business will be written in any of the above states, please ensure an appointment is already in place. L&P APRT4112 Note: This training is intended for agents who are not employees of the listed statutory companies (referred to herein as the “Company”).

New Business Applications. To help expedite new business applications submitted simultaneously with agent appointment paperwork, please include the following information and return with your appointment paperwork: Agent Name Client Name Date new business application was signed State in which the application was signed State in which the client resides Type of business written The following states require an appointment at the time of solicitation:  Alabama  Kansas  Kentucky  Louisiana  Missouri  Montana  Ohio  Pennsylvania  Puerto Rico  Texas  Vermont  Washington  Wisconsin If business will be written in any of the above states, please ensure an appointment is already in place. L&P APRT4112 I am requesting an appointment and agreement with the below company(ies) (each individually referred to as “the Company”).  Stonebridge Life Insurance Company  Transamerica Casualty Insurance Company  Transamerica Financial Life Insurance Company  Transamerica Life Insurance Company  Transamerica Premier Life Insurance Company FIRST: MIDDLE: LAST: SUFFIX: SOCIAL SECURITY NUMBER: DATE OF BIRTH: GENDER: PRIMARY TELEPHONE: SECONDARY TELEPHONE: FAX #: FINRA REGISTERED? IF YES, BROKER-DEALER NAME: E-MAIL ADDRESS: HOME ADDRESS (Mandatory for background investigative report requirements.) STREET: APT#: CITY: STATE: ZIP: COUNTRY: BUSINESS ADDRESS (if different than Home Address): STREET: STE#: P.O. BOX: CITY: STATE: ZIP: COUNTRY: NON-RESIDENT APPOINTMENTS DESIRED: FLORIDA COUNTIES DESIRED: BACKGROUND INFORMATION Yes No