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A member of LifeMark Partners
IPG Central Region - Mike Kelley - Appointment Request

 
Date Requested: May 19, 2012
     
Contact Information
First Name:  
Last Name:  
Phone:  
Email:  
     
Commissions
Appoint an Individual or Corporation?   Individual      Corporation
Are you Assigning Commissions?           Yes                   No
If Yes, Assign Commissions to:      Agency                  B/D            Other
If Yes, Agency or Broker Dealer:        If Other:
     
E & O and Anti-Money Laundering
Do You Have E & O Coverage?           Yes                   No
Does IPG have a Copy?           Yes     No    If No
Have You Completed LIMRA Anti-Money Laundering Training in the Past 12 Months?           Yes       No   When?            
     
License Information
Insurance License:   State     License Number
Does IPG have a Copy?           Yes     No    If No
     
Companies and Products
Carrier Annuity DI Life LTCI VUL
Allianz Life Insurance Company
American General Life Insurance Company
American National
Assurity Life Insurance Company
AVIVA Life Insurance Company
Banner Life Insurance Company
Genworth Financial
Illinois Mutual Life Ins. Co.
ING Reliastar
ING USA Annuity & Life Company
Integrity Life Insurance Company
John Hancock Life Insurance Company
Liberty Life of Boston
Lincoln Benefit Life Company
Lincoln National Life Insurance Company
Metropolitan Life Insurance Company
Minnesota Life
Nationwide Life & Annuity
North American Company for Life & Health
Principal Financial Group
Prudential Ins Co of America
Royal Neighbors of America
Standard Insurance Company
SunLife Financial
Transamerica Life Insurance & Annuity Company
United Of Omaha Life Insurance Company
Variable Annuity Life Insurance Company
West Coast Life Insurance Company
Western Reserve Life
Carrier Annuity DI Life LTCI VUL
     
Already Appointed with this Carrier?         Yes                   No
If Yes, Dual Appoint or Move?          Dual                Move
Notes:  
     
   

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