ASSIGNMENT OF COMMISION Sample Clauses

ASSIGNMENT OF COMMISION. I direct my compensation to be paid as follows: 1. That I shall be an agent assigned to the agency of Diversified Ins Brokers (“the Agency”); 2. That the Company has no obligation to me for commissions, expense allowances or any form of compensation whatsoever in connection with the services performed and expense incurred by me in the solicitation of applications for insurance issued by the Company, it being expressly understood that I am under direct contract with the Agency who has agreed to compensate me for such services; 3. That I shall comply with the rules, regulations and rate books of the Company, the laws of the State of 4. That I shall not alter, modify, waive or change any of the terms, rates or conditions of any advertisements, receipts, policies or contracts of the Company in any respect; 5. That I shall promptly remit to the Agency or the Company any and all monies or securities received by me on behalf of the Company as full or partial payment of first year or renewal premiums, or any other item whatsoever; 6. That I shall not obligate the Company nor incur expense in its behalf in any manner whatsoever; 7. That I shall not attempt systematically to rewrite or replace customers of the Company with other carriers. Should I do so I will forfeit all compensation I would have otherwise been entitled to from the undersigned manager, and my license/appointment with the Company, if still active, shall be revoked immediately; and 8. That the Company may, without liability to me whatsoever upon request of the Agency or upon its own initiative, cancel my license/appointment at any time.

ASSIGNMENT OF COMMISION. I direct my compensation to be paid as follows: 1. Agent Information ❑ Mr. ❑ Ms. ❑ Mrs. Last Name: First Name: Social Security No: Nickname: National Producer Number: Date of Birth: Resident Address (must be actual street address, no P.O. Box) (Street) (City) (State) (ZIP code) Business Address (must be actual street address, no P.O. Box) (Street) (City) (State) (ZIP code) Business Phone: FAX: E-mail Address: Which address is to be used for mailing purposes: ❑ Home Address ❑ Business Address: 2. Commissions (please select one and attach a copy of Agency License) 3. Background Questions (please provide written explanation to all questions answered “Yes”) 1. Have you been appointed or contracted with Companion Life in the past? 2. Have you ever been convicted of, or are currently under, indictment for any criminal felony or misdemeanor? 3. Have you ever been cited, fined, placed on probation, had your licensed suspended or revoked, or paid administrative penalties, entered into a consent order, been issued a restrictive license or otherwise been disciplined or reprimanded or are you currently under investigation by any insurance department or other regulatory authority? ❑ Yes ❑ Yes ❑ Yes ❑ No ❑ No ❑ No