Columbus Life
Insurance Company [GRAPHIC] TOUCHSTONE
[GRAPHIC]
THIS GENERAL AGENCY AGREEMENT ("Agreement") is made and entered into by and
between TOUCHSTONE SECURITIES, INC., a Nebraska corporation, and its undersigned
affiliated insurance agency (herein jointly and severally referred to as
"Touchstone"); the undersigned Broker-Dealer (herein separately referred to as
"Broker-Dealer"); and the undersigned Life Agency (herein separately referred to
as "Life Agency"). Broker-Dealer and Life Agency are herein jointly and
severally referred to as "General Agent."
THIS AGREEMENT sets forth the terms and conditions under which the parties agree
that Touchstone, having been authorized under a separate Distributor Agreement
with Columbus Life Insurance Company ("Company") to obtain and appoint agents of
Company, shall appoint General Agent as a general agent of Company to solicit
for and sell certain variable contracts (the "Contracts") which are described on
the Commission Schedule attached hereto, as the same may be amended from time to
time pursuant to this Agreement.
THE TERM of this Agreement shall commence on the date this Agreement, having
been signed by General Agent, is accepted and executed by Touchstone at its home
office, and shall continue in force until terminated as herein provided.
THIS AGREEMENT includes the attached Terms and Conditions, the attached
Commission Schedule (as amended from time to time), and all other schedules,
exhibits or addenda referencing this Agreement and now or hereafter appended
hereto by Touchstone, all of which are incorporated herein by reference. The
parties agree that this Agreement constitutes the complete and exclusive
statement of the terms and conditions between the parties covering the
performance hereof and cannot be amended, altered or modified except in the
manner provided for in the Terms and Conditions.
1. APPOINTMENT. General Agent is hereby appointed, through its licensed
and appointed individual agents, to solicit and procure applications
for the sale of Contracts on behalf of Company in those states where
General Agent is duly licensed to do so and in those states where
Company is authorized to sell
such Contracts. General Agent shall have no exclusive territory for
the sale of the Contracts. Touchstone shall inform General Agent of
those jurisdictions in which the Contracts may be lawfully sold.
Broker-Dealer warrants and represents that, at all times while this
Agreement is in force, it is and will remain registered as a
broker-dealer with the Securities and Exchange Commission (the "SEC")
and a member of the National Association of Securities Dealers, Inc.
(the "NASD"). Life Agency warrants and represents that, at all times
while this Agreement is in force, it is and will remain licensed as a
life insurance agency under the insurance laws of the various states
in which it operates and Contracts are sold under authority of this
Agreement.
2. AUTHORITY TO SOLICIT AND SELL. General Agent shall have the authority,
pursuant to the rules and regulations of Company and Touchstone, to
solicit sales of the Contracts, obtain completed applications therefor
and accept premiums paid thereon. All applications for the Contracts
shall be on forms duly authorized by Company in accordance with the
insurance laws and regulations of the various states in which such
Contracts are sold. All such applications and the full amount, without
setoff, demand or deduction, of all premiums shall be promptly
remitted to Company in accordance with the rules and regulations of
Touchstone and Company applicable to such transactions.
No solicitation for a Contract shall be made by any person associated
with General Agent unless and until such person has been duly
appointed as an agent of Company in accordance with applicable
insurance laws and regulations. General Agent is not authorized to
solicit for the sale of the Contracts in any jurisdiction where such
product is not duly authorized to be sold.
3. AUTHORITY TO RECOMMEND APPOINTMENT OF AGENTS. General Agent is
authorized to recommend to Touchstone those persons associated with
General Agent who are to be appointed as agents of Company and who are
to be authorized to solicit for the sale of the Contracts in
accordance herewith. General Agent agrees to fulfill all requirements
set forth in the General Letter of Recommendation attached as Schedule
A hereto in conjunction with its submission of licensing and
appointment papers for all proposed agents. Company shall have
absolute discretion to accept or reject such recommendation for the
appointment of any such person as an agent for the sale of the
Contracts. Company shall also have the absolute right to terminate any
such person as an agent of Company. Before any such person approved
for appointment as an agent is permitted to sell the Contracts, such
agent, Broker-Dealer and Life Agency shall have entered into a written
agreement pursuant to which: (i) the agent is appointed as an agent of
Life Agency and a registered representative of Broker-Dealer; (ii)
said agent agrees that his or her selling activities relating to the
Contracts shall be under the supervision and the control of General
Agent; and (iii) that said agent's right
to continue to sell such Contracts is subject to his or her continued
compliance with such agreement and any procedures, rules or
regulations implemented by General Agent.
4. RESPONSIBILITIES OF GENERAL AGENT. In addition to the responsibilities
set forth in Paragraphs 2 and 3 above, General Agent shall:
(a) make reasonable efforts to maintain the Contracts in force and
provide reasonable assistance to owners of the Contracts,
(b) be governed strictly by all rules and instructions of Company and
Touchstone and observe and comply with all applicable securities
and insurance laws and regulations,
(c) train and supervise its agents to insure that purchase of a
Contract is not recommended to an applicant in the absence of
reasonable grounds to believe that the purchase of the Contract
is suitable for that applicant. While not limited to the
following, a determination of suitability shall be based on
information furnished to an agent after reasonable inquiry of
such applicant concerning the applicant's insurance and
investment objectives, other security holdings, financial
situation and needs, and the likelihood that the applicant will
continue to make any premium payments contemplated by the
Contracts and will keep the Contract in force for a sufficient
period of time so that Company's acquisition costs are amortized
over a reasonable period of time,
(d) insure that any offer of a Contract made by a sales agent of
General Agent will be made only by means of a currently effective
prospectus,
(e) shall provide Touchstone with a copy of any agreements or
materials referring to the Contracts and prepared by the General
Agent. All promotional materials making reference to the
Contracts are subject to approval by the Company and Touchstone
before distribution. Notwithstanding the foregoing, neither the
Company nor Touchstone are responsible for the content of any
materials prepared by any General Agent.
(f) keep such records in such form as may be reasonably required by
Company and Touchstone and/or as required under applicable laws
and regulations. Such records and forms and all supplies
furnished to the General Agent by Company shall remain the
property of Company and shall be subject to examination and/or
possession at any time by Company or its authorized
representatives,
(g) pay expenses incurred in the performance of this Agreement,
(h) deliver Contracts immediately, and
(i) promptly notify Touchstone and Company in writing of any customer
complaint or notice of regulatory investigation related to the
Contracts, Broker-Dealer, Life Agency, or any activities
contemplated by this Agreement, of which General Agent becomes
aware.
5. LIMITATIONS OF AUTHORITY. The authority granted to General Agent does
not permit it or any of its sales agents to:
(a) make, alter or discharge any contract to which Company or
Touchstone is a party,
(b) waive or modify any terms, rates, conditions or limitations of
any Contract,
(c) adjust or settle any claim unless specifically directed by
Company or to admit liability on any claim unless authorized to
do so in writing by Company,
(d) enter into any legal proceedings pertaining to Company's or
Touchstone's business without prior written consent. Company or
Touchstone shall not be responsible for any expenses incurred as
a result of these proceedings.
(e) exercise any authority on behalf of Touchstone or Company other
than as authorized by this Agreement,
(f) attempt to bind Touchstone or Company by any promise or
agreement,
(g) incur any debt, expense, or liability in Company's or
Touchstone's name or account without prior written consent,
(h) pay or allow or offer to pay or allow as an inducement to any
person to purchase, any rebate of premium or consideration or any
inducement not specified in the Contract,
(i) allow a writing agent to sign an application for a Contract, as
the writing agent, unless such application was personally taken
by such agent in the presence of the applicant, or
(j) engage in any activity prohibited by federal or state laws
regulating financial institutions.
6. TRAINING, COMPLIANCE AND LICENSING. General Agent shall be responsible
for the training and supervision of all persons appointed as agents
hereunder. General Agent and all persons associated with General Agent
shall, in the solicitation and sale of the Contracts, comply with all
written procedures, rules and regulations of Touchstone or Company
applicable thereto. General Agent and all persons associated with
General Agent shall use only those sales, advertising and promotional
materials which have been approved in writing by Touchstone.
General Agent shall have the responsibility for compliance with all
laws, rules and regulations applicable to the solicitation and sale of
the Contracts by General Agent and by all persons associated with
General Agent.
General Agent, its affiliates, its officers, directors, employees, and
sales personnel, shall obtain and maintain all licenses,
registrations, and appointments required by any law, regulations, or
other requirement of the SEC, the NASD, or of any jurisdiction where
the Contracts are to be sold. General Agent shall immediately notify
Touchstone and Company if any sales persons associated with it cease
to be registered representatives of Broker-Dealer or if General Agent
is disqualified for continued membership with the NASD or registration
with the SEC.
7. COMPENSATION. General Agent shall receive commissions on premiums on
Contracts issued as a result of applications obtained by it and
accepted by Company. Commissions payable hereunder are specified in
the Commission Schedule which is attached hereto and incorporated
herein by reference. Such Commission Schedule may be amended or
modified at any time by Touchstone with 30 days prior written notice.
Any such amendment or modification shall apply only to applications
for Contracts which are obtained by General Agent after the date of
such modification or amendment. All compensation due to General Agent
and its sales persons under this Agreement shall be paid to
Broker-Dealer on behalf of General Agent (assuming Broker-Dealer and
Life Agency are separate persons), or as otherwise required by law. As
between Broker-Dealer and Life Agency, Life Agency hereby appoints
Broker-Dealer as its agent on its behalf to receive and process
commission payments that are required by applicable law to be paid to
Life Agency. Notwithstanding the foregoing, Broker-Dealer agrees to
account for all commissions paid under this Agreement from the sale of
Contracts in accordance with the applicable reporting requirements of
the SEC and the NASD.
If Company, for any reason, refunds any premium or part of a premium
on any Contract, any commissions paid the General Agent on such
premiums that are to be refunded under the Schedule of Commissions
shall at Touchstone's
option be immediately repaid to Touchstone or, at the option of
Touchstone, be deducted from any compensation payable to the General
Agent.
General Agent covenants that all necessary contractual arrangements
shall be in place to allow Touchstone to pay General Agent for
business produced by sales persons associated with General Agent in
the jurisdictions in which they hold licenses. General Agent agrees to
pay all compensation, if any, due to any person, including sales
persons associated with the General Agent, with respect to business
produced pursuant to this Agreement.
The payment of compensation shall always by subject to the General
Agent and/or its sales persons being properly licensed in the
applicable jurisdiction.
8. FIDELITY BOND AND OTHER LIABILITY COVERAGE. General Agent represents
that all directors, officers, agents, employees and associated persons
who are licensed pursuant to this Agreement as Company Agents for
state insurance law purposes or who have access to funds of Company,
including but not limited to, funds submitted with applications for
the Contracts are and shall be covered by a blanket fidelity bond,
including coverage for larceny and embezzlement, issued by a reputable
bonding company. This bond shall be maintained by General Agent at its
expense. Such bond shall be, at a minimum, of the form, type and
amount required under NASD rules, endorsed (if necessary) to extend
coverage to transactions relating to the Contracts. Touchstone may
require evidence satisfactory to it, that such coverage is in force
and General Agent shall give prompt written notice to Touchstone of
any notice of cancellation of the bond or change of coverage.
General Agent hereby assigns any proceeds received from a fidelity
bonding company, error and omissions or other liability coverage, to
Touchstone or Company as their interest may appear, to the extent of
their loss due to activities covered by the bond, policy or other
liability coverage. If there is any deficiency amount, whether due to
a deductible or otherwise, General Agent shall promptly pay such
amounts on demand. This paragraph shall not be construed to limit the
indemnification provided in Section 9 hereof.
9. INDEMNIFICATION. General Agent shall indemnify and hold Touchstone and
Company harmless from any liability arising from any act or omission
of General Agent or of any officer, director, employee of General
Agent or of sales persons associated with General Agent.
General Agent shall indemnify and hold Touchstone and Company harmless
from any claim by a sales person associated with General Agent for
compensation due or to become due on account of such person's sale of
Contracts. General Agent expressly authorizes Touchstone to charge
against
all compensation due or to become due to General Agent under this
Agreement any monies paid or liabilities incurred by Touchstone or
Company under this Section 9.
Touchstone shall indemnify and hold General Agent harmless from any
liability resulting from damages sustained by a Contract owner caused
by acts or omissions of Touchstone; except to the extent General
Agent's acts or omissions caused such liability. Indemnification by
Touchstone is subject to the conditions that General Agent promptly
notify Touchstone of any claim or suit made against General Agent, and
that General Agent allow Touchstone to make such investigation,
settlement, or defense thereof as Touchstone deems prudent.
10. ENTIRE AGREEMENT. This Agreement is the complete and exclusive
statement of the agreement between the parties as to the subject
matter hereof which supersedes all proposals or agreements, oral or
written, and all other communications or letters of intent between the
parties related to the subject matter of this Agreement.
11. MODIFICATION OF AGREEMENT. This Agreement can only be modified by a
written agreement duly signed by the persons authorized to sign
agreements on behalf of the parties. Variance from the terms or
conditions of this Agreement or any order or other written
notification will be of no effect.
12. SEPARABILITY OF PROVISIONS. If any provision or provisions of this
Agreement shall be held to be invalid, illegal, or unenforceable, the
validity, legality, and enforceability of the remaining provisions
shall not in any way be affected or be impaired thereby.
13. ASSIGNMENT. This Agreement and the rights, duties, and obligations of
the parties hereto shall not be assignable by either party hereto
without the prior written consent of the other, and any purported
assignment shall be void.
14. WAIVER. No waiver by either party of any default by the other in the
performance of any promise, term, or condition of this Agreement shall
be construed to be a waiver by such party of any other or subsequent
default in performance of the same or any other covenant, promise,
term, or condition hereof. No prior transactions or dealings between
the parties shall be deemed to establish any custom or usage waiving
or modifying any provision hereof.
15. NOTIFICATION OF CLAIMS, DEMANDS, OR ACTIONS. Each party hereto shall
promptly notify the other in writing of any claims, demands, or
actions having any bearing on this Agreement.
16. PERFORMANCE IN ACCORDANCE WITH LAW. Each party agrees to perform its
obligations hereunder in accordance with all applicable laws, rules,
and regulations now or hereafter in effect. Notwithstanding the
imposition of liabilities and obligations on the Broker-Dealer and
Life Agency acting together as General Agent under this Agreement (if
Broker-Dealer and Life Agency are separate persons), nothing herein
contained shall be construed to relieve Broker-Dealer of any of its
responsibilities or obligations to comply with all applicable federal
and state securities laws and regulations in its performance of this
Agreement; nor shall anything herein contained be construed to relieve
Life Agency of its responsibilities or obligations to comply with all
applicable state insurance laws and regulations in its performance of
this Agreement.
17. BINDING AGREEMENT. This Agreement shall be binding upon and inure to
the benefit of the parties hereto, their successors, and permitted
assigns.
18. ACTS BEYOND THE CONTROL OF THE PARTIES. No liability shall result to
either party, nor shall either party be deemed to be in default
hereunder, as a result of delay in its performance or from its
non-performance hereunder caused by circumstances beyond its control,
including but not limited to: act of God, act of war, riot, epidemic,
fire, flood, or other disaster, or act of government. Nevertheless,
the party shall be required to be diligent in attempting to remove
such cause or causes.
19. RELATIONSHIP OF THE PARTIES. Each of the parties will act as an
independent contractor under the terms of this Agreement and neither
is now, or in the future, an agent, or a legal representative of the
other for any purposes other than as contemplated by this Agreement.
Neither party has any right or authority to supervise or control the
activities of the other party's employees in connection with the
performance of this Agreement or to assign or create any application
of any kind, express, or implied, on behalf of the other party or to
bind it in any way, to accept any service of process upon it or to
receive any notice of any nature whatsoever on its behalf.
20. TERMINATION. This Agreement shall automatically terminate upon breach
by any party of any terms and conditions hereof, or upon the
dissolution, bankruptcy, or insolvency of any party. This Agreement
may be terminated without cause by any party at any time upon 30 days
prior written notice. Termination shall not affect General Agent's
right to any compensation earned on premiums received and accepted by
Company prior to the effective date of such termination, nor shall
termination affect the obligations set forth in Paragraph 9.
21. GOVERNING LAW; CONSTRUCTION. This Agreement shall be governed by and
interpreted in accordance with the laws of the State of Ohio.
Whenever the context requires, all words used in the singular shall be
deemed to include the plural and vice versa, and each gender shall
include the other gender.
22. CAPTIONS. Captions contained in this Agreement are for reference
purposes only and do not constitute part of this Agreement.
23. NOTICE. All notices which are required to be given or submitted
pursuant to this Agreement shall be in writing and shall be deemed
given when deposited with the United States Postal Service, postage
prepaid, registered or certified mail, return-receipt requested to the
last address of record of the party being notified which is maintained
by the other party in the ordinary course of business.
All terms and conditions of this Agreement are hereby agreed to by:
GENERAL AGENT: TOUCHSTONE:
UMB Scout Brokerage Touchstone Securities, Inc.
By:_________________________________ By:__________________________________
Name & Title:_______________________ Name & Title:________________________
And Life Agency(ies): And, its affiliated insurance
Agency Name:________________________ agency(ies):
Agency Name:_________________________
By:_________________________________ By:__________________________________
Name & Title:_______________________ Name & Title:________________________
Agency Name:________________________ Agency Name:_________________________
By:_________________________________ By:__________________________________
Name & Title:_______________________ Name & Title:________________________
Agency Name:________________________ Agency Name:_________________________
By:_________________________________ By:__________________________________
Name & Title:_______________________ Name & Title:________________________
Date: Date Accepted:
Columbus Life
Insurance Company [GRAPHIC] TOUCHSTONE
[GRAPHIC]
COLUMBUS LIFE INSURANCE COMPANY VARIABLE UNIVERSAL LIFE
Commission Schedule
Columbus Life Insurance Company Variable Universal Life (policy series CL 72
9908)
% of End of Policy
Policy Year % of Premium Year Unloaned
Account Value
Year 1 90% of target; 3%* of excess 0%
Years 2-10 3% .25%
Years 11-16 1% .25%
Years 17+ 1% 0%
*0% on any amount of first year premium in excess of $500 per $1,000 of
Specified Amount.
RULES FOR COMMISSION PAYMENTS
In the event of policy lapse or surrender within twelve months from the issue
date of a Policy, General Agent shall refund commissions in accordance with the
following chargeback scale:
# of completed months in force 0-6 7 8 9 10 11 12+
% of commissions recovered 100% 95% 90% 80% 60% 30% 0%
In the event that any Policy shall terminate due to the Owner's election to
return a Policy under its "Free Look" provision, General Agent shall refund 100%
of the commission paid thereon to Touchstone.
Chargebacks may be applied against current and future commissions payable to
General Agent.
COLUMBUS LIFE INSURANCE COMPANY VARIABLE UNIVERSAL LIFE
Commission Schedule (continued)
Pinnacle Variable Universal Life (policy series CL 75 0101)
% of End of Policy
Policy Year % of Premium Year Unloaned
Account Value
Year 1 90% of target; 3% of excess 0%
Years 2 - 6 4.5% of target; 3% of excess .25%
Years 7 - 12 3% of target; 3% of excess .25%
Years 13+ 0% .15%
RULES FOR COMMISSION PAYMENTS
In the event of policy lapse or surrender within twelve months from the issue
date of a Policy, General Agent shall refund commissions in accordance with the
following chargeback scale:
------------------------------------------------------------------------------------------------------------------
# of completed months in force 0-6 7 8 9 10 11 12+
------------------------------------------------------------------------------------------------------------------
% of commissions recovered 100% 95% 90% 80% 60% 30% 0%
------------------------------------------------------------------------------------------------------------------
In the event that any Policy shall terminate due to the Owner's election to
return a Policy under its "Free Look" provision, General Agent shall refund 100%
of the commission paid thereon to Touchstone.
Chargebacks may be applied against current and future commissions payable to
General Agent.
Columbus Life
Insurance Company [GRAPHIC] TOUCHSTONE
[GRAPHIC]
Schedule A to Terms and Conditions of General Agency Agreement
General Letter of Recommendation: General Agent hereby certifies to Touchstone
and Company that all of the following requirements will be fulfilled in
conjunction with the submission of licensing/appointment papers for all
applicants as agents ("applicant") submitted by General Agent. General Agent
will, upon request, forward proof of compliance with same to Touchstone and
Company in a timely manner.
1. We have made a thorough and diligent inquiry and investigation
relative to each applicant's identity, residence and business
reputation and declare that each applicant is personally known to us,
has been examined by us, is known to be of good moral character, has a
good business reputation, is reliable, is financially responsible and
is worthy of a license. Each individual is trustworthy, competent, and
qualified to act as an agent for Company, and to hold himself out in
good faith to the general public. We vouch for each applicant.
2. We have on file a X-000, X-000 or U-4 form which was completed by each
applicant. We have fulfilled all the necessary investigative
requirements for the registration of each applicant as a registered
representative through our NASD member firm, and each applicant is
presently registered as an NASD registered representative.
The above information in our files indicates no fact or condition
which would disqualify the applicant from receiving a license, and all
the findings of all investigative information is favorable.
3. We certify that all educational requirements have been met for the
specific state in which each applicant is requesting a license, and
that all such persons have fulfilled the appropriate examination,
education and training requirements.
4. If the applicant is required to submit his or her picture, signature,
fingerprints and securities registration in the state in which he or
she is applying for a license, we certify that those items forwarded
to Touchstone and Company are those of the applicant and the
securities registration is a true copy of the original.
5. We hereby warrant that the applicant is not applying for a license
with Company in order to place insurance chiefly or solely on his or
her life or
property, lives or property of his or her relatives, or property or
liability of his or her associates.
6. We certify that each applicant will receive close and adequate
supervision, and that we will make inspection when needed of any or
all risks written by these applicants, to the end that the insurance
interest of the public will be properly protected.
7. We will not permit any applicant to transact insurance business as an
agent until duly licensed therefor. No applicants have been furnished
supplies, nor have any applicants been permitted to write, solicit
business or act as an agent in any capacity, and they will not be so
permitted until the certificate of authority or license applied for is
received.
8. We certify that Life Agency, Broker-Dealer and applicant shall have
entered into a written agreement pursuant to which: (i) applicant is
appointed an agent of Life Agency and a registered representative of
Broker-Dealer, (ii) applicant agrees that his or her selling
activities relating to all Contracts shall be under the supervision
and control of General Agent; and (iii) that applicant's right to
continue to sell such Contracts is subject to his or her continued
compliance with such agreement and any procedures, rules or
regulations implemented by General Agent.
Columbus Life
Insurance Company [GRAPHIC] TOUCHSTONE
[GRAPHIC]
Personalized Asset Allocation Agreement
The purpose of this Agreement is to set forth certain arrangements between the
General Agent ("General Agent") signing below and Touchstone Securities, Inc.
("Touchstone"), which relate to the use of the Touchstone Personalized Asset
Allocation program in the purchase and redemption of units of the Columbus Life
Variable Universal Life contracts by clients of the General Agent ("Clients").
1. Intended use of Asset Allocation Program. From time to time Touchstone
may supply brochures and other materials including model portfolio
mixes and investor questionnaires, to General Agent to assist General
Agent in formulating an asset allocation program for Clients. Such
materials are designed to be used and evaluated by the General Agent,
as an investment professional, in light of each Client's individual
circumstances, and are not to be relied upon as investment advice of
the Touchstone.
2. Purchase and Redemption of Units. Any purchase or redemption of
contract units pursuant to the Touchstone Personalized Asset
Allocation program shall be conducted in compliance with the terms and
conditions of the prospectuses for the contracts then in effect. Any
such purchase or redemption shall be made solely upon the instructions
of the General Agent or the Client. Neither the Company nor Touchstone
have any investment authority over any Client's account.
3. Representations and Warranties by the General Agent. The General Agent
hereby represents and warrants that: (a) it is a registered broker
dealer under the Securities Exchange Act of 1934 and is registered in
any state in which it is required to be so registered, and that it
shall comply with all applicable federal and state laws in conducting
its activities, including rules, regulations and interpretations by
governmental and regulatory bodies and self-regulatory organizations
having jurisdiction; and/or (b) it is a registered investment advisor
under the Investment Advisers Act of 1940 and is registered in any
state in which it is required to be so registered, and that it shall
comply with all applicable federal and state laws in conducting its
activities, including rules, regulations and interpretations by
governmental and regulatory bodies and self-regulatory organizations
having jurisdiction.
4. Indemnification. The General Agent shall indemnify and hold harmless
the Company, Touchstone and Transfer Agent against any loss, cost or
expense
(including legal fees) arising out of the purchase or redemption of
Contract units for Clients or the transfer or disbursement of Client
assets in accordance with the instructions of the General Agent.
The parties hereto have entered into this Agreement on
Date ___________________, 19______
GENERAL AGENT:
______________________________ (Name of Broker/Dealer)
______________________________ (Name of Registered Investment
Advisor, if applicable)
______________________________ By (Signature)
______________________________ (Print Name & Title)
______________________________ (Name of Life Agency)
______________________________ By (Signature)
______________________________ (Print Name & Title)
TOUCHSTONE SECURITIES, INC.
______________________________ By (Signature)
______________________________ Name & Title
IFS INSURANCE AGENCY, INC.
______________________________ By (Signature)
______________________________ Name & Title
DATE: ________________________
