Common Contracts

and other long-term care insurance products

Agent Agreement • April 14th, 2005 • New York

• Contract Type
  Agent Agreement
• Filed
  April 14th, 2005
• Jurisdiction
  New York

Contracting Checklist ➢ Complete and return of all required forms & documentation – Incomplete packages will be returned unprocessed.➢ Date ALL Signatures – Undated documentation will be dated with the receipt date by the Company. Applications received dated prior to the contract date will be returned. General Instruction ❑ Page 2 - Producer Profile completed by the Agent and signed & dated by both Agent and Sponsoring General Agent.❑ Page 3 - Agent’s Information Completed.❑ Pages 5 & 6 - Agent’s Signature & Date.❑ Commission Schedule(s) must be signed & attached.❑ Attach copies of resident individual and/or agency state insurance license(s).❑ Attach copy of your Errors & Omissions coverage. State Specific Requirements ❑ Proof of LTC CE Completion required to solicit products in: CO/IL/IN/MD/NC/WA❑ Partnership Certification required to solicit products in: CT & IN❑ Signed Acknowledgement of Training attached for contracting in MA.❑ Signed Contract Addendum attached for contracting in O