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3 Easy Steps General November 2019 Producer Use Only 413144 US (12/19)
3 Easy steps to get contracted with Foresters Financial™
Step 1: Complete the Application for Contract and Appointment
• Complete this easy-to-follow application that contains both the Personal Disclosure
information and the Consent Form for a consumer report. Part II of the application is to be
completed by your NMO/IMO authorized personnel
• Provide complete details of any resident and non-resident licenses on the Application for
Contract and Appointment form for the states you intend to do business with Foresters
Financial. If you do business in Connecticut, New Mexico or Massachusetts, you
need a fraternal license, a life license is not valid. Check out the Fraternal License
Process document for complete details.
• If you do business in New York complete a Certification of Reg 187 Training form.
• Please ensure the name in which all compensation is to be paid is properly licensed, or, in
the case of overrides only, is covered by the states listed in the Override Commission Notice.
Step 2: Print, Sign and Photocopy Appointment Requirements
• Print and complete the Application for Contract and Appointment with Foresters Financial.
• Do not complete Part II of the Application for Contract and Appointment with Foresters
Financial. This is to be completed by your NMO/IMO.
• Print and sign the W9 – Request for Taxpayer Identification number and Certification (not
required for NC contracts).
• Print and sign one copy of the Foresters Financial GA or Producer Agreement.
• Do not fill in the effective date of agreement. This will be completed by Foresters Financial
as it will be the date you are contracted by Foresters Financial. A copy will be returned to
you, once it is counter-signed by Foresters Financial officials.
• Include the Foresters Financial Commission Schedule after discussion with your NMO/IMO.
• Provide a photocopy of your E&O certificate, if not covered by CalSurance’s Foresters
Financial Sponsored Program, confirming that you have current coverage of a minimum of
$1 million for each claim and $1 million claims aggregate for each policy period.
• Include a voided check. All producers will be paid weekly on Friday’s by direct deposit.
Step 3: Forward Appointment Requirements from step 2 to your recruiter
The full contracting & appointment process must be completed prior to or upon your first sale,
or in advance of your first sale in any of the following strict states.
Connecticut* Louisiana Massachusetts* New Mexico* Pennsylvania
*Fraternal states require a fraternal license as life licenses are not valid in a fraternal state.
You will receive an email notification when your application is received and when your
appointment has been approved.
Questions? Contact a Contract Administrator in Contracting and Compensation Services
at 1 866 466 7166.
Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal benefit
society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.
New York Regulation 187 Training
New York Regulation 187 requires life licensed producers doing business in New York to complete training. You
must complete this training prior to submitting new business to Foresters Financial™ or recommending certain
types of inforce transactions to New York residents on Foresters certificates after January 31, 2020. You are
not authorized to make these submissions or recommendations , after that date, until this training has been
completed.
Training consists of Regulation 187 training through an approved vendor and Foresters product training.
For the Regulation 187 training:
- Existing producers are to submit the completed certification of training form (below) to
agencyadmin@foresters.com.
- New producers are to submit the completed certification of training form (below) with their contract
application.
Producers will be asked to certify completion of Foresters product training in the applicable suitability form
submitted with each New York client application.
Certification of New York Regulation 187 Training
I certify that I have completed the required New York Regulation 187 training within the 12 months preceding
the date of this certification. I further certify that I understand I must take Foresters product training prior to
submitting applications for, or servicing, Foresters products.
Please provide details below:
(i) I have completed the required New York Regulation 187 training through: (check as applicable)
LIMRA RegEd
Other (please provide a copy of the course outline and certification document)
(ii) Date (month and year) of most recent completion of New York Regulation 187 training:
Foresters reserves the right to verify the information outlined herein and to require you to immediately
complete appropriate training if not completed as required.
I understand that a false statement or material omission including a failure to provide updated information
may disqualify me from consideration for a contract / appointment with Foresters as a Producer or result in
the subsequent termination for cause of my business relationship with Foresters and may cause Foresters to
report me to the insurance regulator.
_______________________________________ ____________________________________
Date (mm/dd/yyyy)
Signature of Producer
___________________________________
Print Name
Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal benefit society,
789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.
106073 NY 12/19
Application for Contract and Appointment with Foresters
1. General Information

Producer General Agent Sole proprietorship Partnership Corporation
Are you the owner of the corporation? Yes No If yes, what percentage share do you own? ___________
Licensed Corporate Name, if applicable ___________________________________________________________________________________
Gender Title First Name Middle Name
Male Female Mr. Mrs.
Ms. Miss _________________________________ ________________________________
Last Name Maiden Name (or other name used)
_______________________________________________________ __________________________________________________________________
Email Address ____________________________________________________________________________________________________________
Social Security Number __________________________________ Birthdate (mm/dd/yyyy) __________________________________________
Marital Status __________________________________________ Spouse’s Name __________________________________
_______________
2. Business Address (Please note, P.O. Boxes are not acceptable.)
Address _________________________________________________________ Suite #____________ City ________________________________
State ___________________________ Zip Code _____________________ Phone ( ) _______________________________________
Fax ( ) _____________________________________________ Cell ( ) _______________________________________________
3. Home Addresses over last 5 years (Please note, P.O. Boxes are not acceptable.)
Current Address ______________________________________________________ Apt #_____________ City ___________________________
State __________________________ Zip Code ______________________ Phone ( ) ______________________________________
How long at present address? ____________________________ How long at previous address? ______________________________
Previous Address __________
________________________________________ Apt #_____________ City ______________________________
State ___________________________ Zip Code ____________________
4. Banking Information (Include a voided sample check with paperwork)
Account Holder Name ________________________________________ Bank Routing Number ______________________________________
Account Type Checking Savings Account Number ________________________________________________
5. License Information (Include information for all states you want to write business in.) (Use section 8. if more space is required.)
State Effective Date Class of Business* Expiry Date License Type License Number
_____________ ________________ _________________ _________________ Resident Non-Resident __________
______________
_____________ ________________ _________________ _________________ Resident Non-Resident __________
______________
_____________ ________________ _________________ _________________ Resident Non-Resident __________
______________
For Florida Non-Resident please indicate applicable counties: _______ _______ _______ _______ _______ _______ _______
*Life, Life & Health, Life & Annuity, Life, Annuity & Health, Fraternal
NOTE: A fraternal license is required to writ
e business in Connecticut, Massachusetts and New Mexico.
419513A US (12/20)
6. Errors and Omissions Coverage
Do you have errors and omissions (E&O) coverage? Yes (If yes, attach proof of current coverage and provide complete details)
No (If no, have you applied for Foresters’ E&O Group coverage, Yes No )
Coverage Amount
Effective Date Expiry Date Carrier Name Policy Number Certificate Number
______________________ _______________ _______________ ________________________________ ______________________ _____________
_________
If no, E&O coverage is mandatory and must be in the amount of $1 million. Foresters’ sponsored group E&O coverage is available
to all producers contracted with Foresters. For details and access to CalSurance’s easy on-line enrollment, please go to their
website at http://www.calsurance.com/iof
or email Info@Calsurance.com or call CalSurance at 1-800-745-7189.
Has any policy or application for E&O insurance on your behalf ever be
en declined, cancelled or renewal refused, or have you ever made
a claim against any such policy? Yes No (If yes, provide complete details in Additional Information Section below.)
7. Personal Disclosure Profile
a. List other business or personal names used in the financial services sector in the last 5 years.
__________________________________________________________________________________________________________________________
(Corporation, business style, trade name or partnership)
b. Driver’s License Number _____________________________________________________ Issuing State _
_____________________________
c. Are you legally entitled to work in the US?.............................................................................................................................................. Yes No
If you answer “yes” to any of
the following questions, provide details in Additional Information Section below. Such disclosures are
requested in connection with your anticipated sale of insurance products.
d. Have you ever been employed/contracted by and/or submitted business to Foresters?............................................................ Yes No
If yes, indicate the name through which this business was submitted. ______________________________________________________
e. Have you ever been charged with, convicted of, or pled guilty or no contest to a felony or misdemeanor or
are any such proceedings pending?.............................................................................................................................................................. Yes No
f. Have you ever had an insurance and/or securities license denied, suspended, or revoked by a state insurance
department or been the subject of any disciplinary or administrative action, or fined or penalized or are any such
proceedings pending?....................................................................................................................................................................................... Yes No
g. Have you ever had any interruptions in licensing? ................................................................................................................................ Yes No
h. Do you have an outstanding debit balance with any insurance company?.................................................................................... Yes No
i. Have you ever filed for bankruptcy?............................................................................................................................................................ Yes No
If yes, is the bankruptcy active or pending?.............................................................................................................................................. Yes No
If no, in what year was the bankruptcy discharged? ___________________
j. Are any financial obligations in arrears or in collection? ..................................................................................................................... Yes No
If yes, what is the current total amount all of those overdue debts $____________________________
8. Additional Information From Previous Sections (Indicate the question number you are responding to.)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
9. Declarations
I expressly hereby declare that the information I have provided in this Application for Contract / Appointment is complete and accurate in every
respect, as of the date of signing.
I swear or affirm that I have read and understand the items and instructions on this document and that my answers are true and complete to the
best of my knowledge. I understand that I am subject to termination if I give false or misleading answers.
I agree that Foresters (hereinafter the “Company”) can verify my background information using an independent source concerning my credit
record, my business record, my record of criminal convictions, and any other information relevant to my application to and sales relationship with
the Company.
I understand and agree that I must execute and deliver the enclosed consent and authorization to the Company.
I agree to notify and provide updated information to the Company within 10 business days, should there be any change in the information provided
in their application form or in my ability to legally continue to sell life insurance and health insurance.
I understand that a false statement or material omission including a failure to provide updated information may disqualify me from consideration
for a contract / appointment with the Company as a Producer or result in the subsequent termination for cause of my business relationship with
the Company and may cause the Company to report me to an insurance regulator.
____________________________________________________________ _______________________________________________________________
Date (mm/dd/yyyy) Signature of Applicant
419513A US (12/20)
10. Notice, Consent and Authorizations
Notice and Consent Concerning Consumer Reports For
Contract and Appointment Application Purposes
I acknowledge and understand that The Independent Order of Foresters (Foresters), either may request, or has decided to
request, consumer reports or investigative consumer reports in connection with my application for contract / appointment or
during the course of my contract / appointment, if any, with Foresters. Any information contained in such reports may be taken
into consideration in evaluating my suitability for contracting / appointment. Such reports, if obtained, will be prepared by a
consumer-reporting agency and may contain information concerning my credit standing or worthiness, character, general
reputation, personal characteristics, or mode of living. The types of reports that may be requested, include, but are not limited
to, credit reports, Vector One searches to determine the presence of any unpaid, commission-related debit balances with any
insurance company, criminal records checks, court records checks, and/or summaries of educational and employment records
and histories.
The information contained in such reports may be obtained from public record sources or through personal interviews with my
neighbors, friends, associates, current or former employers, or other personal acquaintances.
If Foresters requests an investigative consumer report, which would include personal interviews as described above, I
understand that I will, through my National/Independent Marketing Organization (NMO/IMO) that recommended me for this
application for contracting appointment, receive a second notice indicating that such a report has been requested no later than
three days after the request is made to a consumer reporting agency. This additional notice, if issued, will advise me as to my
further rights pertaining to investigative consumer reports.
If any adverse decision is made with regard to my application for contracting / appointment, if any, based entirely or in part on
the information contained in a consumer report, I understand that I will be notified, through my recommending NMO/IMO, as to
the basis of that decision and given a copy of the report, as well as a summary of my applicable rights through my
recommending NMO/IMO. As well, in advising the recommending NMO/IMO, of the decision to decline my application for
contracting/appointment, Foresters shall have the right to share with the recommending NMO/IMO any information contained in
the consumer report or investigative consumer report as it relates to that decision. It is further understood that Foresters is a
Vector One subscriber and, upon termination for any reason, any qualifying outstanding debit balance may be immediately
reported to Vector One and removed only when the debt has either been paid in full or meets the Vector One threshold.
I understand my consent is required by law before Foresters may obtain a consumer report or investigative consumer report
pertaining to my potential contracting / appointment or actual contracting / appointment, if any, with Foresters or for Foresters
to share information contained in the consumer report or investigative consumer report with the recommending NMO/IMO.
Consent Statement
I have carefully read and understand this Notice and Consent form and, by my signature below, consent to the release of
consumer or investigative consumer reports, as defined above, to The Independent Order of Foresters (Foresters) in
conjunction with my application for contracting / appointment or in connection with any future decisions concerning my
contracting / appointment with Foresters, if any. I also consent and direct any and all notices, copies of reports and a
summary of applicable rights, as defined above, to be sent by Foresters, as well as consent to the release of information
contained in the consumer report or investigative consumer report, to the NMO/IMO that recommended me for this application
for contracting appointment. By signing this Notice and Consent Form I agree that I have reviewed and am also signing the
Vector One Debit-Check Agent/Agency Authorization Form that is incorporated into and forms part of this application.
I further understand that this consent will apply during the course of my contracting / appointment with Foresters, should I
obtain such contracting / appointment, and that such consent will remain in effect indefinitely until revoked in a written
document signed by me. I further understand that any and all information contained in my contracting / appointment
application or otherwise disclosed to Foresters by me may be utilized for the purpose of obtaining the consumer reports or
investigative consumer reports requested by Foresters, and confirm that all such information is true and correct.
Signature of Applicant
Direct Deposit Authorization
The payor, The Independent Order of Foresters, is hereby authorized to deposit on my behalf with the financial institution
designated in section 4. Banking Information, credit payments due on account of commission earnings, and if necessary, to
adjust or reverse a deposit for any commission payment entry made in error to my account.
Date (mm/dd/yyyy)
11. Direct Deposit Authorization
Signature of Applicant
Date (mm/dd/yyyy)
419513A US (12/20)
12. a) Anti-Money Laundering Training
Have yo
u taken AML training?
Yes, I have taken AML training. Please complete 12. b) Certification of Anti-Money Laundering Training
No, I have not completed the required AML training.
Foresters will be in touch with you by email following receipt of your contract paperwork and will provide you with instructions
about taking the required AML training.
12. b) Certification of Anti-Money Laundering Training
Certification of Anti-Money Laundering Training
Pursuant to United States regulatory requirements for insurance producers to complete anti-money laundering (AML) training, I certify
that I have completed the required AML training within the 12 months preceding the date of this certification.
Please provide details below:
(i) I have completed the required AML training through: (check as applicable)
LIMRA FINRA RegEd sponsored by CUSO 360 Training
Other (please provide details in the form of copies of course materials and certification document)
(ii) Approximate date (month and year) of most recent completion of AML training:
Foresters reserves the right to verify the information outlined herein and to require you to immediately complete appropriate AML training
if such training has in fact not been completed within the 12 months preceding the date of this certification.
I understand that a false
statement or material omission including a failure to provide updated information may disqualify me from consideration for a contract /
appointment with the Company as a Producer or result in the subsequent termination for cause of my business relationship with the
Company and may cause the Company to report me to an insurance regulator.
____________________________________________________________ _______________________________________________________________
Date (mm/dd/yyyy)
Signature of Applicant
13. New Business
Have you written any Foresters new business that you have submitted or will be submitting?
No
Yes
Application signed date for the earliest piece of new business written: ________________________________________________________
State in which new business was written in: _______________________________________________________________________________
Has new business been submitted to Foresters for processing?
Yes No
419513A US (12/20)
Page 5 of the Application for Contracting and Appointment With Foresters
Reporting Details
To be completed by NMO/IMO Management
14. Producer Information
Last Name_________________________________________________ First Name ___________________________________________________
Producer Number__________________________________________
(Producer number will be assigned by Foresters)
15. Reporting Hierarchy
NMOName _____________________________________________________
IMO Name _____________________________________________________ Producer Number _________________________________
Recruiter Name _____________________________________________________ Producer Number _________________________________
16. Compensation Details
Traditional Products (non-PlanRight) PlanRight (Final Expense)
Foresters Commissions Schedule: Foresters Commission Schedule:
_______________________________________ ________________________________________
Commission to be paid weekly (default) or Daily
First Year Commissions (Check one) As Earned or,
Annualized (Complete and submit Advanced Commission Addendum form with the
application)
Notes: Notes:
_______________________________________________________ _______________________________________________________
_______________________________________________________ _______________________________________________________
_______________________________________________________ _______________________________________________________
_______________________________________________________ _______________________________________________________
17. Recruiter Approval
I have interviewed the above named Applicant and I am aware of nothing which precludes me from reasonably recommending the Applicant for
contract / appointment with Foresters.
_
____________________________________ ___________________________________________
Date (mm/dd/yyyy) Recruiter Signature
419513A US (12/20)
PHP AGENCY INC
571127
0
0
POLICIES TO BE AGENT DELIVERY
NC Producer Agreement 1 OCTOBER 2016
THE INDEPENDENT ORDER OF FORESTERS
Producer Agreement
This Producer Agreemen
t (“Agreement”) is made between The Independent Order of Foresters
(“Foresters”) and __________________________________________ (hereinafter referred to as
“you” or “your” or “Producer”), effective this _______ day of _____________________, 20_____.
1. PURPOSE
The Agreement allows Foresters to compensate _____________________________________ (the
“Agency”) for your personal sales of its Certificates of Insurance (“Certificates”) issued by Foresters
that are sold by you on behalf of Foresters.
2. APPOINTMENT AND AGREEMENT
Foresters hereby appoints you as a Producer to solicit business on its behalf and you agree to
represent Foresters as an independent contractor in accordance with the terms of this Agreement,
all applicable Foresters internal policies, procedures and rules including, but not limited to, the
presentation of the Foresters Story and member benefits therein, and the laws and regulations of
the state(s) in which you operate. You agree to submit to such supervision as may be necessary to
ensure compliance with these policies, procedures, rules, laws and regulations.
You shall not have exclusive rights of solicitation for any product issued by Foresters or for any
geographic territory and you agree to obtain and maintain any state insurance license(s) necessary
to solicit business on behalf of Foresters. You shall ensure that no individual shall offer or sell the
Certificates on your behalf in any state other than the jurisdiction(s) in which the Certificates may
be lawfully sold.
You are not authorized to recruit licensed producers, or promote life insurance sales through other
licensed producers, on behalf of Foresters.
3. RELATIONSHIP
You are an independent contractor and nothing in this Agreement, or any other agreement
between you and Foresters, shall be construed to create the relationship of employee and employer
between you and Foresters or, if you are a corporation, between any officer, employee, licensed
producers or other associated person of yours. As an independent contractor, you are free to
operate in the manner you deem appropriate, subject to the applicable laws and regulations. You
are totally responsible for all business expenses you incur as an independent Producer.
4. COMPENSATION
You hereby
direct and authorize Foresters to pay any commissions, or other compensation if any,
due on business sold by you to the Agency directly, and you waive all right, title and interest to any
commissions or other compensation from Foresters in connection with the solicitation of business
and placement with Foresters. The amount of any commissions or other compensation payable to
you on Foresters business shall be determined and paid in accordance with your contractual
arrangement with the Agency. You understand and agree that you will be compensated solely by
the Agency and will receive no commissions or other compensation from Foresters.
5. LIMITATION
OF AUTHORITY
You agree not to perform any acts on behalf of Foresters for which you are not authorized, such as:
a. Accept risks, incur debt or liability or make contracts in the name of Foresters;
NC Producer Agreement OCTOBER 2016 2
b. Waive, alter, modify or change any Foresters Certificate, terms, rates or customary
requirements;
c. Endorse checks payable to Foresters;
d. Deliver Certificates except in accordance with Foresters instructions and during the good health
of the proposed insured;
e. Accept premiums except for the limited exception of initial premiums in accordance with
Foresters procedures, which in no circumstances would include the acceptance of premiums in
cash;
f. Adjust or settle any Certificate claim;
g. Conduct any advertising whatsoever involving Foresters, its name or Certificates, without the
prior written approval of Foresters; or,
h. Notwithstanding item g. above, use Foresters trademarks, service marks, trade names, logos,
or other commercial or product designations (collectively “Marks”) for any purpose whatsoever
without the prior written approval of Foresters. Nothing in this Agreement shall be construed as
prior written approval for you to use Foresters Marks.
6. DUTIES
Producer hereby agrees that its duties and responsibilities shall include, but not be limited to, the
following:
a. To complete Certificate application pursuant to Foresters policies and procedures, and to notify
Foresters promptly should you become aware of: the death of the applicant insured; any
inaccuracies in the applicant’s responses to the application; or any changes to the applicant’s
responses generally on the application, or as to the condition of health and insurability, before
the Certificate is delivered.
b. To submit all applications for Certificates directly to Foresters and to hold any monies collected
on behalf of Foresters and remit them promptly to Foresters.
c. To comply with all applicable laws of each state where such Certificates are marketed and with
all of Foresters rules and procedures for the sale of Certificates.
d. To service and use best efforts to help keep the Certificates in force that you sell for Foresters.
e. To obtain written approval from an officer of Foresters prior to the publication of any written
material whatsoever regarding Foresters or its Certificates, unless such material has been
furnished to Producer by Foresters for use.
f. To provide reasonable access during normal business hours to any location, from which
Producer conducts its business and provides services to Foresters pursuant to this Agreement,
to auditors designated in writing by Foresters for the purpose of performing audits for
Foresters. Foresters shall give reasonable advance written notice of an audit and include in that
notice the matters that it will audit. Producer shall provide the auditors any assistance they
may reasonably require. Such auditors shall have the right during normal business hours to
audit any business record, activity, procedure, or operation of Producer that is reasonably
related to the business marketed under this Agreement, including the right to interview any
personnel involved in providing or supporting such responsibilities.
g. To comply with all applicable laws and regulations impacting the use and disclosure of private
information. In respect thereof, the Producer will: not use or disclose nonpublic personal
information, i.e. personally identifiable information including, but not limited to, financial or
h
ealt
h information that is not publicly available (“Protected Information”), about individuals who
seek to obtain Products and/or services through Foresters (“Consumers”), and/or members of
Foresters, except as provided herein; treat Protected Information as confidential and access to
Protected Information will be limited to officers, employees, agents and representatives of
Producer who need to use the information in connection with underwriting, claims
administration or other servicing of Products and/or services for a particular Consumer or
member; not use or disclose, or permit any of its officers, employees, agents or representatives
to use or disclose, Protected Information except: (i) as necessary in underwriting, administering
claims, or otherwise servicing the Consumer and/or member transactions requested or
authorized by the Consumer and/or member; (ii) as otherwise in compliance with the Foresters
NC Producer Agreement OCTOBER 2016 3
privacy policy; or, (iii) as otherwise permitted and/or state regulations and legislation; and,
establish appropriate procedures for safeguarding Protected Information within Producer’s
control.
h. Use the Foresters Story and/or member benefits as an inducement in the solicitation for or sale
of securities or securities products.
7. SOLICITATION RIGHTS
You agree that Foresters will have, at all times both during and after the termination of this
Agreement, the right to communicate in any fashion with any of the persons insured under the
Certificates issued hereunder for any purpose, including but not limited to: advertising Foresters’
products, benefits and services; responding to inquiries; conservation of business; servicing the
Certificates; and, adjusting claims.
8. CONFIDENTIALITY, COMPANY PROPERTY
You understand and agree that certain information received from Foresters including, without
limitation, information concerning Foresters members or customers, may be proprietary and/or
confidential in nature, and that you shall use all such information solely for purposes of soliciting
Certificates pursuant to this Agreement.
Foresters will furnish you such Certificates, forms, advertising matter, diskettes, and other
supplies, as it may deem necessary. The title to these Foresters materials, as well as all
undelivered Certificates, books supplies or other property furnished to you, shall be vested in
Foresters and shall be accounted for and delivered to its authorized representative upon the
termination of this Agreement, or at any time on demand.
9. INDEMNIFICATION
Each party is responsible to the other for its acts or omissions of its employees This shall include
any monetary fines or forfeitures, and associated administrative costs, imposed by any regulatory
body by order or decree. Foresters reserves the right to withhold any amounts due from you under
this provision from commissions payable to you.
10. TERMINATION
10.1 Termination Without Cause
This Agreement may be terminated without cause by you or by Foresters at any time upon written
notice by either party mailed to the other party at the last known address of such other party.
Such termination shall be effective 5 days after mailing.
10.2 Automatic Termination
This Agreement will automatically be terminated immediately upon: your death (upon dissolution if
a partnership or corporation); filing for bankruptcy, insolvency or assignment for the benefit of
creditors; failure to continuously maintain all required licenses; or, upon the termination of
Foresters Agreement with your National Marketing Organization, if any.
10.3 Termination For Cause
This Agreement may be terminated for cause for your:
a. material violation of any of the terms of this Agreement , including, but not limited to, the
limitations of Authority and Duties therein, or of any amendment or addendum made a part
hereof;
b. neglect to report or pay to Foresters any premiums collected on its behalf;
c. material violation of any state or federal law or regulation or of Foresters new business
solicitation and application rules;
NC Producer Agreement OCTOBER 2016 4
d. inducing, or attempting to induce, any Certificate holder of Foresters to stop premium
payments or surrender a Certificate, the latter which includes the withdrawal of values with
the intent of allowing the Certificate to lapse; or,
e. providing confidential information or materials including member information acquired from
Foresters to any competitor or potential competitor.
Termination of this Agreement shall automatically terminate any supplements, addenda,
amendments or Schedules made a part of this Agreement.
11. ERRORS AND OMISSIONS INSURANCE
You agree to obtain and maintain errors and omissions insurance coverage providing for each
policy period: minimum coverage of $1,000,000 for each claim; $1,000,000 claims aggregate; and,
use best efforts to require the errors and omissions insurer to provide notice to Foresters if that
coverage is terminated for any reason, including a lapse for non-payment of premium.
12. ARBITRATION
All disputes, controversies or differences between you and Foresters, its employees or agents,
which arise under or are related to this Agreement, including, without limitation, the construction,
performance or breach of any agreement, upon which an amicable understanding cannot be
reached within 30 days following written notice of the dispute being delivered to the other party,
shall, upon the written request of either party, be settled and determined by arbitration in
accordance with the commercial Arbitration Rules of the American Arbitration Association, and
judgment upon the award entered by the arbitrators may be entered in any court having
jurisdiction of these matters, with the exception that claims relating to contractual or equitable
indemnity between you and Foresters, its employees or agents, arising out of claims brought by
third parties shall not be arbitrated, in the absence of a further agreement between the parties.
Disputes relating to such claims may be resolved in the court where the third party action is
pending.
In arbitration, the parties will have the right to conduct civil discovery and bring motions, as
provided by the Federal Rules of Civil Procedure. However, there will be no right or authority for
any dispute to be brought, heard or arbitrated as a class or collective action, as a private attorney
general, or in a representative capacity on behalf of any person. Likewise, nothing in this provision
shall preclude either party from obtaining any provisional remedies prior to the commencement or
completion of the arbitration that are permitted under the laws of the state governing this
Agreement.
13. ENTIRE AGREEMENT
You understand that this Agreement constitutes the entire Agreement between you and Foresters
and supersedes any and all previous agreements between you and Foresters; provided however,
that this Agreement does not release you from any ongoing obligations that are owed by you to
Foresters under any prior agreement. No modification or amendment of this Agreement will be
valid unless in writing by a Vice President of Foresters.
14. WAIVER
Failure of Foresters to insist upon strict compliance with any provision of this Agreement or rule of
Foresters shall not constitute a waiver of the provision or rule.
15. ASSIGNMENT
The rights and benefits of Foresters under this Agreement shall be transferable, and all provisions
hereunder shall inure to the benefit of, and be enforceable by, its successors and assigns.
NC Producer Agreement OCTOBER 2016 5
16. GOVERNING LAW
It is mutually agreed that all questions and issues relating to the validity of or performance under
this Agreement shall be governed by the laws of the state of the Producer’s principal place of
business.
17. SEVERABILITY AND SURVIVABILITY OF CONTRACTUAL PROVISIONS
All rights of Foresters will survive the termination of this Agreement and, notwithstanding the
foregoing, Sections 6g, 7, 8, 9 and 12 shall survive the termination of this Agreement.
The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or
enforceability of any other provision hereof, and any invalid or unenforceable provision shall be
deemed to be severable.
19. DUPLICATE ORIGINALS
This Agreement may be executed in two or more counterparts, each of which for all purposes,
when executed and delivered, shall be deemed an original and all of which shall constitute the
same instrument.
THIS AGREEMENT CONTAINS A BINDING ARBITRATION PROVISION THAT MAY BE
ENFORCED BY THE PARTIES.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
________________________________ ______________________________________
Witness Producer Signature
______________________________________
Print or Type Name of Producer
Title: _________________________________
ONLY if Producer is a corporation
Date: _________________________________
The Independent Order of Foresters
By: ___________________________________
Signature
Title: __________________________________
Date: _________________________________
Debit-Check Agent/Agency Authorization Form
Vector One Operations, LLC dba Vector One (collectively with its affiliates, "Vector One") manages the secured web portal
interactive computer service provided by Debit-Check.com, LLC a ("Debit-Check"). This Debit-Check Agent/Agency Authorization
Form is by and among the undersigned ("you", "me", "I" or "my"), Vector One, and the Company (as defined below) and is used by
Debit-Check subscribers who desire to be granted authorization from you for the submission and/or receipt of your personal
information to the Debit-Check service as necessary to conduct a commission related debit balance screening. The undersigned
company and its affiliates and authorized third parties (collectively, the "Company") is a Debit-Check subscriber. Accordingly, as part
of the contracting and appointment process or determination of eligibility for advancement of commissions, the Company may
conduct a commission related debit balance screening via Debit-Check in order to determine your eligibility and may continue to
conduct periodic commission related debit balance screenings as determined in the Company's sole discretion following the
engagement of any employment, appointment, contract, tenure, or other relationship with the Company.
Access to Debit-Check Information: You can obtain your commission related debit balance information by contacting the Vector
One Agent Hotline at (800) 860-6546.
AGENT/AGENCY’S STATEMENT – READ CAREFULLY
The Company is hereby authorized to obtain and conduct a commission related debit balance screening through Vector One's
Debit-Check secured web portal to determine if another Debit-Check subscriber has posted that I have an outstanding commission
related debit balance. I understand that the Company may consider the results of the commission related debit balance screening
in order to determine my eligibility to be contracted and appointed or determine my eligibility for advancement of commissions as
an insurance producer and may continue to conduct periodic commission related debit balance screenings as determined in the
Company's sole discretion following the engagement of any employment, appointment, contract, tenure, or other relationship with
the Company. I understand and acknowledge that the Company may obtain commission related debit balance information through
Debit-Check as state law allows. I understand that my information, including my name and social security number ("My Information")
may be used for the purpose of obtaining and conducting a commission related debit balance screening. I further understand that
in the event of termination or expiration of my employment, appointment, contract, tenure, or other relationship with the Company,
whether voluntary or involuntary, if a commission related debit balance is owed to the Company, the Company may post My
Information to the Debit-Check service which may be accessed by Debit-Check subscribers until such time the debit balance is
satisfied or otherwise removed.
BY SIGNING BELOW, I HEREBY (PLEASE INITIAL ALL STATEMENTS):
(A) ________ Authorize the Company to use My Information for purposes of conducting a commission related debit
balance screening, and periodic commission related debit balance screenings as determined in the Company’s sole discretion
following the engagement of any employment, appointment, contract, tenure, or other relationship with the Company, utilizing Debit-
Check.
(B) ________ Authorize the Company to consider the results of the commission related debit balance screening in
order to determine my eligibility to be contracted and appointed or determine my eligibility for advancement of commissions as an
insurance producer.
(C) ________ Authorize and direct Vector One to receive and process My Information as necessary to intentionally
disclose and furnish the results of my commission related debt verification screening, whether directly or indirectly, to the Company.
(D) ________ Authorize the Company to submit My Information to the Debit-Check service in the event of termination
or expiration of my engagement with the Company, whether voluntary or involuntary, to the extent a commission related debit
balance is owed to the Company.
(E) ________ Authorize and direct Vector One to receive and process My Information and intentionally disclose to
any Debit-Check subscriber who submits an inquiry utilizing My Information the results of my commission related debit balance
screening, which will contain My Information, to the extent a debit balance is owed.
Agent/Agency Printed Name:
Signature: Date:
FOR COMPANY USE ONLY
AGREED AND ACKNOWLEDGED BY COMPANY:
Name of Company:
Signature:
Name and Title:
State Solicitation Rules Producer Use Only 413920 US (06/2016)
Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a
fraternal benefit society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.
Important Notice:
Please read before writing any Foresters Financial™ business
Point of Sale Business
Foresters Financial will send you a “welcome” email the same day we start the contracting
process. When we send out this welcome email, we also send a notice to Apptical - our POS
tele-interviewing partner. The update to the Apptical system takes place overnight. So,
when you receive a “welcome” email, you can take this as a signal that you can call Apptical
to conduct a POS interview the day after you receive your “welcome” email.
State Solicitation Rules
Any business written prior to a producer being licensed or, any business written during a gap
between a license expiry date and license renewal date where a producer did not hold an
active license, cannot be processed by Foresters Financial and the business will be refunded
and returned to the applicant.
Producers are not permitted to solicit business for Foresters Financial in a Strict
State, per list below, prior to being licensed, contracted and appointed with Foresters
Financial. Any business that is written prior to the producer being contracted and appointed
cannot be issued and the new business application will be cancelled and any monies collected
and submitted with the new business application will be refunded to the applicant.
Strict States
Connecticut* Louisiana Massachusetts* New Mexico* Pennsylvania
*Fraternal states require a fraternal license as life licenses are not valid in a fraternal state.
Refer to the Fraternal License Process document for details.
Producers can write business in non-strict states, prior to Foresters Financial approval for
contract, however that business will not be issued for delivery by the producer nor will any
commissions be paid to the producer for that business until the producer is approved,
contracted and appointed by Foresters Financial. In the event a producer’s application for
contract is declined or not proceeded with (NPW), and that producer has written business,
that pending business cannot be processed and the new business application will be cancelled
and any monies collected and submitted with the new business application will be refunded to
the applicant.
Producers who are already contracted and later go on to obtain an additional resident/non-
resident license in a strict state in which they are not yet appointed by Foresters Financial,
are not permitted to solicit business for Foresters Financial in that strict state, until they are
appointed in that state. Any business that is written prior to being appointed cannot be
issued and the new business application will be cancelled and any monies collected and
submitted with the new business application will be refunded to the applicant.
Override Commission Notice Producer Use Only 413919 US (06/2016)
Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal
benefit society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.
Override Commission Notice
As determined by Foresters Financial
TM
, in its sole discretion, certain states and the District of Columbia
(“jurisdictions”) by their insurance laws allow override commissions to be paid to an insurance agency or
agent without that insurance agency or agent holding an active license in those jurisdictions. Foresters
Financial will make override commission payments to any insurance agency or agent who does not
participate in the sale of insurance policies, as defined below, in those “included jurisdictions”, pursuant to
the terms and conditions of their respective appointment agreement with Foresters Financial and subject to
the following additional conditions.
Included jurisdictions:
Alabama District of Columbia Louisiana Nebraska Oklahoma Vermont
Alaska Hawaii Maine Nevada Oregon Washington
Arkansas Idaho Maryland New Hampshire Rhode Island West Virginia
Arizona Illinois Michigan New Jersey South Carolina Wisconsin
California Indiana Minnesota New York South Dakota Wyoming
Colorado Iowa Mississippi North Carolina Tennessee
Connecticut Kansas Missouri North Dakota Texas
Delaware Kentucky Montana Ohio Utah
Excluded jurisdictions (where active license required):
Florida ² Georgia Massachusetts New Mexico Pennsylvania Virginia
Additional Conditions
1. The insurance agency or agent will not “sell, solicit or negotiate” insurance business in any of the above
named jurisdictions. Additionally, in California and Texas, the insurance agency or agent will not service
or transact matters subsequent to the sale of the insurance contract and arising out of it as an insurance
agent in the state.
Definitions:
“sell” means to exchange a contract of insurance by any means, for money or its equivalent, on
behalf of an insurance company.
“solicit” means attempting to sell insurance or asking or urging a person to apply for a particular
kind of insurance from a particular company.
“negotiate” means the act of conferring directly with, or offering advice directly to, a purchaser or
prospective purchaser of a particular contract of insurance concerning any of the substantive
benefits, terms or conditions of the contract, provided that the person engaged in that act either
sells insurance or obtains insurance from insurers for purchasers.
2. ²Incorporated insurance agencies in the State of Florida do not have to be licensed to receive override
commissions. If your agency is not incorporated you will require a resident or non-resident license to
receive overrides.
3. It is the responsibility of the insurance agency or agent to notify Foresters Financial of license details for
licenses held in any of the abovementioned excluded states (or the State of Florida for other than
incorporated insurance agencies), or their actual holding or obtainment of a license in any of the above
named included jurisdictions.
4. This Override Commission Notice is effective as of June 1, 2007 and thereafter, unless amended or
withdrawn by Foresters Financial at any time in its sole discretion.
Fraternal License Process
For Connecticut, Massachusetts and New Mexico
In order to sell life insurance for Foresters Financial™ and receive compensation in
Connecticut, Massachusetts and New Mexico, producers and business entities must hold a
fraternal life license and be appointed with Foresters Financial as a fraternal agent, before
any sales occur.
1. Complete the applicable State Application for Fraternal Agent’s License form.
2. Make check or money order for a fraternal license fee payable in the correct amount to
the appropriate state noted in the table above. Submit the completed paperwork and
check/money order to:
Foresters Financial
Contracting and Compensation
Services 789 Don Mills Road
Toronto, Ontario, Canada M3C
1T9
3. License fee will be reimbursed by Foresters Financial following placement of first piece of
business with Foresters Financial.
Foresters Financial will complete and authorize the appointment form(s) and mail the entire
package to the applicable Department of Insurance. The average processing time for the
state is approximately 10 business days.
State
Type of
License
License
Fee
Payment
Made
Payable to
Fraternal Application Details
and Forms Required
Connecticut
Individual
Resident or
Non-Resident
$130.00
Payment must
be made
through online
application
process
Note: If there
are any issues
in applying for
the Fraternal
Line of
Authority
(LOA), please
contact NIPR
at 855-674-
NIPR (6477)
Apply for the Fraternal Line of
Authority (LOA) online through
www.NIPR.com Once approved
submit a copy to Foresters.
Business
Entity
Resident or
Non-Resident
Note: Producers operating under a
corporate name must also obtain a
business entity life license in order
to receive compensation in that
name.
417134 US (01/19)
Page 1 of 2
Massachusetts
Individual
Resident or
Non-Resident
n/a
Foresters pays
$6.00
appointment
fee
Complete a Massachusetts
Fraternal License Application found
on the Get Contracted page under
Fraternal License Process.
Business
Entity
Resident or
Non-Resident
In order to apply for a business
entity resident or non-resident
license, contact the Massachusetts
Department of Insurance for
assistance at 617 521 7794.
New Mexico
Individual
Resident or
Non-
Resident
$30.00
Payment must
be made
through online
application
process
Note: If there
are any issues
in applying for
the Fraternal
Line of
Authority
(LOA), please
contact NIPR
at 855-674-
NIPR (6477)
Apply for the Fraternal Line of
Authority (LOA) online through
www.NIPR.com Once approved
submit a copy to Foresters.
Business
Entity
Resident or
Non-
Resident
Apply for the Fraternal Line of
Authority (LOA) online through
www.NIPR.com Once approved
submit a copy to Foresters.
Note: Producers operating under
a corporate name must also
obtain a business entity fraternal
license in order to receive
compensation in that name.
Renewal fees associated with the Fraternal License and Appointment will be the responsibility of
the Producer/Business Entity.
Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal benefit
society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.
Page 2 of 2 Producer Use Only
417134 US (01/19)
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Completed 17 July 2021

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