In making this application, it is understood that an Investigative Report requesting information as to character, general reputation, personal characteristics, credit report, criminal record, and mode of living may be made. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided.
THIS COMMISSION AGREEMENT is made on the day of , , between Direct Benefits, Inc. whose business office is located at 325 Cedar Street Suite 800 Saint Paul MN 55101, hereinafter referred to as "Company" and
hereinafter referred to as "Producer".
IN CONSIDERATION of the mutual premises and upon the terms and conditions set forth herein, the parties do hereby agree: I. Duties a. Producer agrees to solicit and service group insurance companies and plans available through Company's carrier relationship(s). b. Producer is not authorized to any indebtedness or liability, or to make, alter, or discharge contracts, or to waive forfeitures, extend time payments due, waive payment in cash, or make refunds or rebates, or to name additional rates on behalf of the Company. c. Producer is not authorized to accept or receive money due carrier except in accordance with the rules and regulations of carrier and/or Company. Cash collected by Producer from customers in accordance with such rules and regulations for group insurance policies and plans underwritten by carrier shall be immediately remitted to carrier; any check made payable to Producer shall be endorsed to carrier and immediately remitted to carrier. All other instruments shall be immediately remitted to carrier. d. Producer agrees not to otherwise interfere with the other business activities of Company or its other representatives. e. All sales hereunder and subject to approval by Company and carrier at its office. Therefore, all applications and other instruments for insurance coverages hereunder shall be immediately forwarded to Company. f. Producer shall maintain all licensing, continuing education, and other producer compliance requirements of the insurance laws and regulations of the jurisdiction in which he/she solicits group insurance policies and plans for Company's carrier. II. Territory This agreement does not assign a territory to Producer. Producer warrants and represents that he/she is licensed and otherwise has the legal right to solicit, sell and service insurance in accordance with this Agreement. III. Compensation Compensation to Producer shall be a percentage of premium as set forth on the attached Schedule of Commissions. Such compensation may be amended from time to time by Company. Commissions shall be payable upon receipt and acceptance by carrier of total premiums due so long as Producer remains Producer of record. Compensation may be assigned in writing with the written consent of Company. Producer is responsible for all expenses by him/her in performing the duties described herein. IV. Return of Materials On termination of this contract by either party, all sales manuals, brochures, applications, forms, premium information, customer account lists, invoices and other sales materials and any copies thereof shall be promptly returned to Company by Producer. V. Indebtedness Any indebtedness of Producer to Company shall be a first lien against any commissions due Producer, his representatives, or assigns under this Agreement and such commissions will be applied to liquidate such indebtedness. VI. Arbitration Should a dispute or claim arise or remain unresolved between Company and Producer under this Agreement, both parties agree to arbitrate according to the rules of the American Arbitration Association. The prevailing party of any arbitration shall be entitled to reasonable attorney's fees, if any, and other expenses incurred in connection to such arbitration. This Section Six shall survive termination of this Agreement. VII. Termination This agreement may be terminated by either party on not less thirty (30) days written notice. If termination is by Company, it is agreed that such termination may be with or without cause. VIII. Modifications This Agreement does not preclude carrier from amending or rescinding any insurance contract written with respect to this Agreement. Unless otherwise stated herein, the terms of this agreement shall not be altered, amended, or modified except in writing signed by a duly authorized representative/officer of Company, and shall be construed according to the laws of the state of Minnesota.
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I have read and agree to all the Terms & Conditions
For and in consideration of value received, I, (name) of (city)(state) do hereby bargain, sell, assign, transfer,set over and convey unto (assignee) all of my right, title, interest claim or demand in and to any and all commissions, first year and renewal, due or to become due and payable to me by Pan American Life Insurance Company (PALIC), new Orleans, Louisiana, under and in accordance with that certian Commision Agreement dated , 20, entered into by and between PALIC and myself.
Executed this day of , 20
