Common use of What Information We Collect Clause in Contracts

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” 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.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting ActAs an insurance producer, your skills and services help our clients achieve financial success and security. Since you are on the front lines of a multi-billion dollar industry, you are in a unique position not only to serve our clients, but also to serve this country by helping prevent money laundering and the financing of terrorist activities. To comply with new federal anti-money laundering regulations for insurance companies, our family of companies is implementing a detailed anti-money laundering program. You have an important role to play in that program. You may often be in a critical position to obtain information regarding the customer, the customer’s source of funds for the products we sell, and the customer’s reasons for purchasing an insurance product. That in selling individual annuities and life insurance, the Company’s anti-money laundering program requires you must: • Ensure that all information requested on the product application and associated documents is accurate and complete, including the USA PATRIOT Act Notification and Customer Identification Verification form for all non-variable business. • Contact the appropriate Anti-Money Laundering (AML) compliance officer if a customer resists providing information. (See contact information further in this document.) - Records of this information must be retained as amendedlong as the contract remains in force and for five years thereafter. • Notify the appropriate AML compliance officer if you detect any money laundering red flags, provides so that any consumer reporting agency may furnish the Company can determine whether a consumer suspicious activity report in accordance (SAR) must be filed with the written instructions U. S. Department of the consumer Treasury or any agency thereof. Possible Red Flag Activity (for a comprehensive list of red flag activity, contact the AML officer at American National) The purchase of a product that appears to whom it relates. In accordance be inconsistent with a customer’s needs • The purchase or funding of a product that provisionappears to exceed a customer’s known income or liquid net worth • Any attempted unusual method of payment, particularly by cash or cash equivalents, such as money orders or cashier checks • Payment of a large amount broken into several smaller amounts • Little or no concern by a customer for the person signing this form as "Applicant" hereby authorizes any person or agency performance of an insurance product, but much concern about the early termination features of the product • The reluctance by a customer to give, in writing, orallyprovide identifying information, or in any the provision of information that seems fictitious • Any other form, to American National Insurance Company 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 activity which you think 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” 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.suspicious

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting ActSTATEMENT OF POLICY ON PRODUCER DEVELOPED ADVERTISING AMERICAN NATIONAL INSURANCE COMPANY (Company) INDEPENDENT MARKETING GROUP (IMG) Agents, as amendedBrokers, provides that any consumer reporting agency may furnish a consumer report in accordance Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the Company through IMG are required to secure written instructions Home Office approval prior to the use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and prospective agents. Detailed Advertising Guidelines are available on IMG’s web site xxx.xxx.xxxxxxxx.xxx, Compliance Issues, Field Reference Manual, Compliance Section. The Company must review and approve any advertisement that: · Refers to the Company · Refers to the Company’s industry ratings and/or financials · Refers to any Company product · Refers to policy or operational/administrative procedures of the consumer to whom it relates. In accordance with that provisionCompany · Describes features of a Company product, or the person signing this form as "Applicant" hereby authorizes features of any person or agency to giveproduct, in writing, orally, or in any other form, to American National Insurance Company 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 such detail that it can be used or collected in whole or in part for the purpose of serving identified as a factor in establishing Company product · Targets current or potential agents (recruiting ads) if the Applicant's eligibility for credit, employment or advertisement has any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as features listed above · Is attached to or a part of its normal procedure, request any mailing or distribution of an approved Company ad · Is used on any Web site · Is used in the State of Florida that an investigative consumer credit report be made whereby information on could result in the Applicant's character, general reputation, personal characteristics or mode sale 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 Insurance Company 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 Insurance Company 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 ANICO products whether or not American National Insurance the Company will make an offer of a contract name or its products are mentioned. Agents, Brokers and other Producers should submit advertisements to their Marketing Organization for review, approval and forwarding to the Applicantappropriate IMG marketing representative. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this AgreementRegistered Representatives of Broker-Dealers should submit advertisements to their Broker-Dealer. After such review, and you accept your appointment subject advertisements should be submitted to the terms and conditions of this Agreement and all related Schedules and Supplements related to itIMG for review.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current cur rent or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” 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.

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial financial information, including information about transactions with other financial financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting Act, as amended, provides that This notice is for your information and does not require any consumer reporting agency may furnish a consumer report in accordance with action on your part. PP04 ST-905 Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company 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 Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any Virginia Bureau Insurance Code. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company 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 pertinent Administrative Letters may be acquainted or who located via the Bureau of Insurance website at: Date Print Name Social Security Number / Tax ID Number Branch Office Number (If known) ALABAMA Both $40 -­‐ Agency & Ind $40 -­‐ Agency & Ind Yes ALASKA Agency N/A N/A Yes ARIZONA Agency N/A N/A Yes ARKANSAS Both N/A N/A Yes CALIFORNIA Agency $29 $29 Yes COLORADO Agency N/A N/A Yes CONNECTICUT Both $50 -­‐ Agency & Ind $50 -­‐ Agency & Ind Yes DELAWARE Both $25 -­‐ Agency & Ind $25 -­‐ Agency & Ind Yes DIST. OF COLUMBIA Agency $25 $25 Yes FLORIDA Both $60 -­‐ Agency & Ind *402 for all counties not including FL fee $60 ($6 per county 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 Insurance Company 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 apply) -­‐ Agency & Ind *402 for all counties 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. including FL fee Yes GEORGIA Both $14.84 $14.84 HAWAII* Agency N/A N/A Yes IDAHO Agency N/A N/A Yes ILLINOIS Agency N/A N/A Yes INDIANA Agency N/A N/A Yes IOWA Individual (Applicant's Printed NameAgency license optional) Retaliatory Retaliatory Yes KANSAS Agency $5 $5 Yes KENTUCKY Agency $40 $50 LOUISIANA Agency $20 $20 Yes MAINE Both $30-­‐ Agency & Ind $45 -­‐ Agency & Ind Yes MARYLAND Agency N/A N/A Yes MASSACHUSETTS Agency $75 $75 Yes MICHIGAN Both $5 -­‐ Agency & Ind $5 -­‐ Agency & Ind Yes MINNESOTA Both $30 $30 Yes MISSISSIPPI Both $25 $25 Yes MISSOURI Agency N/A N/A Yes MONTANA Agency N/A N/A Yes NEBRASKA Both Retaliatory Retaliatory Yes NEVADA Agency $15 $15 Yes NEW HAMPSHIRE Both $25 -­‐ Agency & Ind $25 -­‐ Agency & Ind Yes NEW JERSEY Agency $25 $25 Yes NEW MEXICO Both $20 $20 Yes NEW YORK Agency N/A N/A Yes NORTH CAROLINA Both $10 life + $10 health $10 life + $10 health No NORTH DAKOTA Both $10 -­‐ Agency & Ind $10 -­‐ Agency & Ind Yes OHIO Both $15 life + $15 health -­‐ Agency & Ind $15 life + $15 health -­‐ Agency & Ind Yes OKLAHOMA Both $30 -­‐ Agency & Ind $30 -­‐ Agency & Ind Yes OREGON Agency N/A N/A Yes PENNSYLVANIA Both N/A N/A No RHODE ISLAND Individual (Applicant's SignatureAgency license optional) Form 4708 Rev. 09/07 American National Insurance Company N/A N/A Yes SOUTH CAROLINA Both N/A N/A Yes SOUTH DAKOTA Both $10 -­‐ Agency & Ind $20 -­‐ Agency & Ind Yes TENNESSEE Individual (hereinafter designated as “Company”Agency license optional) hereby appoints its GENERAL AGENT $15 $15 Yes TEXAS Agency $10 $10 Yes UTAH Agency N/A N/A Yes VERMONT Individual (“GA” or “you”Agency license optional) 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.$60 $60 Yes VIRGINIA Both $10 -­‐ Agency & Ind $10 -­‐ Agency & Ind Yes WASHINGTON Agency $20 $20 Yes WEST VIRGINIA Agency $25 $25 No WISCONSIN Individual (Agency license optional) $16 $40 Yes WYOMING Both $15 -­‐ Agency & Ind $15 -­‐ Agency & Ind Yes Updated 5/23/17

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current cur rent or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting ActAgents, as amendedBrokers, provides that any consumer reporting agency may furnish a consumer report in accordance Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the Company through IMG are required to secure written instructions Home Office approval prior to the use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and prospective agents. Detailed Advertising Guidelines are available on IMG’s web site xxx.xxx.xxxxxxxx.xxx, Compliance Issues, Field Reference Manual, Compliance Section. The Company must review and approve any advertisement that: · Refers to the Company · Refers to the Company’s industry ratings and/or financials · Refers to any Company product · Refers to policy or operational/administrative procedures of the consumer to whom it relates. In accordance with that provisionCompany · Describes features of a Company product, or the person signing this form as "Applicant" hereby authorizes features of any person or agency to giveproduct, in writing, orally, or in any other form, to American National Insurance Company 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 such detail that it can be used or collected in whole or in part for the purpose of serving identified as a factor in establishing Company product · Targets current or potential agents (recruiting ads) if the Applicant's eligibility for credit, employment or advertisement has any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as features listed above · Is attached to or a part of its normal procedure, request any mailing or distribution of an approved Company ad · Is used on any web site · Is used in the State of Florida that an investigative consumer credit report be made whereby information on could result in the Applicant's character, general reputation, personal characteristics or mode sale 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 Insurance Company 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 Insurance Company 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 ANICO products whether or not American National Insurance the Company will make an offer of a contract name or its products are mentioned. Agents, Brokers and other Producers should submit advertisements to their Marketing Organization for review, approval and forwarding to the Applicantappropriate IMG marketing representative. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) Registered Representatives of Broker- Dealers should submit advertisements to their Broker-Dealer. The Broker-Dealer should forward such advertisements, including any developed by the Broker-Dealer, to the NASD for review if applicable. Once reviewed by the NASD, the Broker-Dealer should forward such advertisements to the appropriate IMG marketing representative, along 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 itNASD comment letter.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting ActAgents, as amendedBrokers, provides that any consumer reporting agency may furnish a consumer report in accordance Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the Company through Life and Annuity Distribution are required to secure written instructions Home Office approval prior to the use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and prospective agents. The Company must review and approve any advertisement that: • Refers to the Company • Refers to the Company's industry ratings and/or financials • Refers to any Company product • Refers to policy or operational/administrative procedures of the consumer to whom it relates. In accordance with that provisionCompany • Describes features of a Company product, or the person signing this form as "Applicant" hereby authorizes features of any person or agency to giveproduct, in writingsuch detail that it can be identified as a Company product • Targets current or potential agents (recruiting ads) if the advertisement has any of the features listed above • Is attached to or a part of any mailing or distribution of an approved Company ad • Is used on any Web site • Is used in the State of Florida that could result in the sale of ANICO products whether or not the Company name or its products are mentioned. Agents, orallyBrokers and other Producers should submit advertisements to their Marketing Organization for review, approval and forwarding to the appropriate Life and Annuity Distribution marketing representative. Registered Representatives of Broker-Dealers should submit advertisements to their Broker-Dealer. After such review, advertisements should be submitted to Life and Annuity Distribution for review. An advertisement is not approved by the Company unless the Marketing Organization or the Broker-Dealer has received final, written approval from Life and Annuity Distribution. An advertisement that is returned to the Marketing Organization or Broker-Dealer for correction(s)/changes is not considered approved until all correction(s)/changes have been made as indicated by the Company. Once all correction(s)/changes have been made and the advertisement has been re-submitted to Life and Annuity Distribution final, written notification will be sent to the Marketing Organization or Broker-Dealer who should notify the Agent, Broker, Producer, or Registered Representative that the advertisement has been approved by the Company. A final copy of the advertisement in any other form, to American National Insurance Company 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 form it 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 Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report must 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 provided to Life 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 Insurance Company 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” 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 itAnnuity Distribution.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. Effective May, 2006, ANICO implemented an AML program to comply with federal anti-money laundering regulations for insurance companies. The Federal Fair Credit Reporting Actregulations apply to all individual life insurance and annuities (includes individually sold group products), as amendedindividual registered life insurance and annuities, 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 Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company or its designated representatives Producers will be required to use the reports furnished receive periodic AML training in accordance with this authorization in any deliberations which it or they may undertake order to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” 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.

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. The Federal Fair Credit Reporting Act, as amended, provides that This notice is for your information and does not require any consumer reporting agency may furnish a consumer report in accordance with action on your part. PP04 ST-905 Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company 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 Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any Virginia Bureau Insurance Code. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company 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 pertinent Administrative Letters may be acquainted or who located via the Bureau of Insurance website at: Date Print Name Social Security Number / Tax ID Number Branch Office Number (If known) ALABAMA Both $40 , Agency & Ind $40 , Agency & Ind Yes ALASKA Agency N/A N/A Yes ARIZONA Agency N/A N/A Yes ARKANSAS Both N/A N/A Yes CALIFORNIA Agency $29 $29 Yes COLORADO Agency N/A N/A Yes CONNECTICUT Both $50 , Agency & Ind $50 , Agency & Ind Yes DELAWARE Both $25 , Agency & Ind $25 , Agency & Ind Yes DIST. OF COLUMBIA Agency $25 $25 Yes FLORIDA Both $60 , Agency & Ind *402 for all counties not including FL fee $60 ($6 per county may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to giveapply) , in writingAgency & Ind *402 for all counties not including FL fee Yes GEORGIA Both $14.84 $14.84 HAWAII* Agency N/A N/A Yes IDAHO Agency N/A N/A Yes ILLINOIS Agency N/A N/A Yes INDIANA Agency N/A N/A Yes IOWA Individual (Agency license optional) Retaliatory Retaliatory Yes KANSAS Agency $5 $5 Yes KENTUCKY Agency $40 $50 LOUISIANA Agency $20 $20 Yes MAINE Both $30, orallyAgency & Ind $45 , or any other formAgency & Ind Yes MARYLAND Agency N/A N/A Yes MASSACHUSETTS Agency $75 $75 Yes MICHIGAN Both $5 , to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's productionAgency & Ind $5 , persistencyAgency & Ind Yes MINNESOTA Both $30 $30 Yes MISSISSIPPI Both $25 $25 Yes MISSOURI Agency N/A N/A Yes MONTANA Agency N/A N/A Yes NEBRASKA Both Retaliatory Retaliatory Yes NEVADA Agency $15 $15 Yes NEW HAMPSHIRE Both $25 , commissionsAgency & Ind $25 , earningsAgency & Ind Yes NEW JERSEY Agency $25 $25 Yes NEW MEXICO Both $20 $20 Yes NEW YORK Agency N/A N/A Yes NORTH CAROLINA Both $10 life + $10 health $10 life + $10 health No NORTH DAKOTA Both $10 , estimated future earningsAgency & Ind $10 , commission advances loansAgency & Ind Yes OHIO Both $15 life + $15 health , and debtsAgency & Ind $15 life + $15 health , includingAgency & Ind Yes OKLAHOMA Both $30 , but not limited toAgency & Ind $30 , any indebtedness that may have been charged to the Applicant's manager or agencyAgency & Ind Yes OREGON Agency N/A N/A Yes PENNSYLVANIA Both N/A N/A No RHODE ISLAND Individual (Agency license optional) N/A N/A Yes SOUTH CAROLINA Both N/A N/A Yes SOUTH DAKOTA Both $10 , or which may have been written off. The Applicant authorizes American National Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. Agency & Ind $20 , Agency & Ind Yes TENNESSEE Individual (Applicant's Printed NameAgency license optional) $15 $15 Yes TEXAS Agency $10 $10 Yes UTAH Agency N/A N/A Yes VERMONT Individual (Applicant's SignatureAgency license optional) Form 4708 Rev. 09/07 American National Insurance Company $60 $60 Yes VIRGINIA Both $10 , Agency & Ind $10 , Agency & Ind Yes WASHINGTON Agency $20 $20 Yes WEST VIRGINIA Agency $25 $25 No WISCONSIN Individual (hereinafter designated as “Company”Agency license optional) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement$16 $40 Yes WYOMING Both $15 , and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.Agency & Ind $15 , Agency & Ind Yes Updated 5/23/17

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 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 !" In consideration 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 my appointment by American National Insurance Company 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 company (“American National Insurance Company 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 Insurance Company 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 Insurance Company 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 Insurance Company will make an offer of a contract to the Applicant. (Applicant's Printed Name) (Applicant's Signature) Form 4708 Rev. 09/07 American National Insurance Company (hereinafter designated as “CompanyNational”) to solicit applications for American National, I hereby appoints its GENERAL AGENT (“GA” 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.agree: