Common use of Timeframe of the Assignment Clause in Contracts

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc. Direct Deposit/Electronic Funds Transfer (EFT) Request for Agent/Broker Commissions New Agreement Change Bank Account

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / /   /  /  (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. ________________________________________     (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) D irect Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+ Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+  Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!!  Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. _ (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+ • Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! • Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+ • Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! • Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the AssignorAssig nor, hereby sellhere by sel l, assign a ssign and transfer xxxx sfer to the Assignee named Ass ignee name d above, its legal representative le gal repres entative or assignsassi gns, the commissionsth e commiss ions, other compensationcom pensation, and payments a nd p ayments now due or which become due on business specified above b ecome du e o n busi ness sp ecified a xxxx after the date this Assignment th is Assignme nt is recorded by UnitedHealthcare. I authorize the Assigneeauthor ize t he Assi gnee, its legal it s leg al representative(s) and a nd assign(s) to collect all such s uch commissions and other compensation com pensation and paymentspa yments. These commissions T hese commissio ns and other compensation and an d payments are for the AssigneeAssig nee’s full use fu ll us e and benefit. I ratify and confirm all al l that the t he Assignee, its legal leg al representative(s) and assign(sassig n(s) lawfully do or cause to be done don e by virtue of this Assignment. This Assignment Assignme nt is subject to all the terms and provisions prov isions of any contracts an y co ntracts that may ma y be in force between AssignorAssign or, Assignee, and a nd UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me p aid m e good and valuable consideration an d va luable cons ideration for this AssignmentA ssignment. I understand that UnitedHealthcare und erstand th at Unite dHealthcare is not responsible r esponsible for the validity, sufficiencys ufficiency, or tax consequences ta x c onsequences of this AssignmentAssig nment. I understand und erstand that I am solely responsible for notification and a m sole ly resp onsible f or not ification a nd any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Version ID: ASM_STD_UHG_102004 Page 11 of 12 Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+ • Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! • Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc. Off Direct Deposit/Electronic Funds Transfer (EFT) Request for Agent/Broker Commissions New Agreement Change Bank AccountAccount Cancel Agreement

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit• Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! • Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form Section 1: Producer Information Producer Name SSN or Tax ID Producer Address: Street Producer Phone # City State Zip Producer Email Authorization Agreement for Automatic Deposits (ACH Credits) I hereby authorize UnitedHealth Group, 000 Xxxxxxx Xxxx, XX 0, Xxxxx Xxxx, XX 00000, hereinafter called COMPANY, to initiate credit entries and, if necessary, debit entries and adjustments for any credit entries in error to my (our) checking/savings account(s) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same account. Direct DepositAdd Change Cancel Depository Name Phone # City State Zip *Routing/Electronic Funds Transfer (EFT) Request for Agent/Broker Commissions New Agreement Change Bank AccountABA # Checking Savings Acct # Full Deposit Percent Specify % amount:

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: OwnerDate Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. +  Please include a voided check or savings deposit slip with this form; otherwise, President, Officer, etcthe form will be returned to you and electronic funds deposit will be delayed. Direct DepositDO NOT SEND A CHECKING DEPOSIT SLIP!!!  Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Version ID: ASM_STD_UHG_102004 Page 12 of 13 Authorization for Automatic Deposit This form will update account information associated to commissions processed by AHCP. Direct DepositTo update direct deposit information for commissions processed by an insurance carrier you must complete the carriers direct deposit authorization form. Forms are located in the AHCP Forms Library. Agent or Agency Name Social Security Number or Tax ID Number Phone Number Email Address Please indicate transaction type: [ ] Set-Up [ ] Change [ ] Cancel Please indicate type of account: [ ] Checking [ ] Savings Name of Financial Institution: Bank—City, State, Phone Number: Routing Number: Account Number: I hereby authorize AHCP to initiate direct deposit of commissions and, if necessary, make corrections for any entries made to my account in error. Agent Signature Date PLEASE INCLUDE A COPY OF A VOIDED CHECK Fax this form to AHCP– 888.781.0586 Scanned versions of this form can be emailed to xxxxxxxxxxx@XXXXxxxxx.xxx PRODUCER AGREEMENT This PRODUCER AGREEMENT (“Agreement”) is entered into by and between America’s Health Care/Electronic Funds Transfer RX Plan Agency, Inc., a Delaware Corporation and its affiliate companies, including Quotit Corporation, Health Compare Insurance Services, Inc. and Velapoint LLC, which are all indirect subsidiaries of Allstate Insurance Company (EFT) Request for collectively “AHCP”), and as Agent (“Agent/Broker Commissions New ”). The Agreement Change Bank Accountshall become effective upon Agent’s licensure and appointment.

Timeframe of the Assignment. New Assignment Effective Immediately (current date will be used) The assignment is effective on / / (If the assignment should be effective before or after the current date, please specify the date.) No retro change of assignment is permitted if commissions were already paid to a previous Assignee. I, the Assignor, hereby sell, assign and transfer to the Assignee named above, its legal representative or assigns, the commissions, other compensation, and payments now due or which become due on business specified above after the date this Assignment is recorded by UnitedHealthcare. I authorize the Assignee, its legal representative(s) and assign(s) to collect all such commissions and other compensation and payments. These commissions and other compensation and payments are for the Assignee’s full use and benefit. I ratify and confirm all that the Assignee, its legal representative(s) and assign(s) lawfully do or cause to be done by virtue of this Assignment. This Assignment is subject to all the terms and provisions of any contracts that may be in force between Assignor, Assignee, and UnitedHealthcare, including but not limited to retention of first lien, security interest and offset rights against the assigned commissions and other compensation and payments to secure payment of any indebtedness which I or the Assignee may now or in the future owe to UnitedHealthcare. I agree to indemnify and hold UnitedHealthcare harmless from any amounts which UnitedHealthcare pays under this Assignment. I hereby certify that this Assignment is the result of an arm’s length agreement between the Assignee and myself and that the Assignee has paid me good and valuable consideration for this Assignment. I understand that UnitedHealthcare is not responsible for the validity, sufficiency, or tax consequences of this Assignment. I understand that I am solely responsible for notification and any contractual obligations that I may have with a previous Assignee when I request to change the assignment. Agent (Signature of Assignor) (Date) (Title: Owner, President, Officer, etc.) Direct Deposit Authorization/Maintenance Form All newly appointed UnitedHealthcare producers receiving commissions are required to have their payments electronically deposited into their bank accounts. Direct Deposit+ • Please include a voided check or savings deposit slip with this form; otherwise, the form will be returned to you and electronic funds deposit will be delayed. DO NOT SEND A CHECKING DEPOSIT SLIP!!! • Verify the nine-digit Routing/Electronic Funds Transfer (EFT) Request ABA number that is preprinted on your check or savings account deposit slip with the financial institution to be used for Agent/Broker Commissions New Agreement Change Bank Accountdirect deposit of your commission funds