Common use of What Information We Collect Clause in Contracts

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company Company Guide to Anti-Money Laundering Program As an insurance producer, your skills and services help our clients achieve financial success and security. Since you are on the front lines of a multi-billion dollar industry, you are in a unique position not only to serve our clients, but also to serve this country by helping prevent money laundering and the financing of terrorist activities. To comply with new federal anti-money laundering regulations for insurance companies, our family of companies is implementing a detailed anti-money laundering program. You have an important role to play in that program. You may often be in a critical position to obtain information regarding the customer, the customer’s source of funds for the products we sell, and the customer’s reasons for purchasing an insurance product. That in selling individual annuities and life insurance, the Company’s anti-money laundering program requires you must: • Ensure that all information requested on the product application and associated documents is accurate and complete, including the USA PATRIOT Act Notification and Customer Identification Verification form for all non-variable business. • Contact the appropriate Anti-Money Laundering (AML) compliance officer if a customer resists providing information. (See contact information further in this document.) - Records of this information must be retained as long as the contract remains in force and for five years thereafter. • Notify the appropriate AML compliance officer if you detect any money laundering red flags, so that the Company can determine whether a suspicious activity report (SAR) must be filed with the U. S. Department of the Treasury or its designated representatives any information gathered agency thereof. Possible Red Flag Activity (for a comprehensive list of red flag activity, contact the AML officer at American National) The purchase of a product that appears to be inconsistent with a customer’s needs • The purchase or maintained funding of a product that appears to exceed a customer’s known income or liquid net worth • Any attempted unusual method of payment, particularly by cash or cash equivalents, such as money orders or cashier checks • Payment of a large amount broken into several smaller amounts • Little or no concern by a consumer reporting agency bearing on customer for the Applicant's credit worthinessperformance of an insurance product, credit standing, credit capacity, character, general reputation, personal characteristicsbut much concern about the early termination features of the product • The reluctance by a customer to provide identifying information, or mode the provision of living information that seems fictitious • Any other activity which you think is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.suspicious AML Contact Information

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial financial information, including information about transactions with other financial financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting ActThis notice is for your information and does not require any action on your part. PP04 ST-905 Standard Life and Accident Insurance Company I American National Life Insurance Company of Texas Marketing Office: 0000 Xxxxx Xxxxx Xxxx., as amendedXxxxx 000 X Xxxxxx Xxxx, provides that any consumer reporting agency may furnish a consumer report in accordance with XX 00000 I Phone: 000.000.0000 I Fax: 000.000.0000 INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any Virginia Bureau Insurance Code. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant pertinent Administrative Letters may be acquainted or who may have knowledge concerning any such items located via the Bureau of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtainedwebsite at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy print corporate name & principal of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Namecorporation.) (Applicant's Signature) (Date) (Social Security NumberNumber / Tax ID Number Branch Office Number (If known) Form 4708 Rev. 09/07 AMERICAN NATIONAL ALDVA ST-1061 R0815 License & Appointment Fees STATE REQUIRED Licenses for Agency Appointments (Agency/Indvididual) Appointment Fee NR Appointment Fee Simultaneous Submission ALABAMA Both $40 -­‐ Agency & Ind $40 -­‐ Agency & Ind Yes ALASKA Agency N/A N/A Yes ARIZONA Agency N/A N/A Yes ARKANSAS Both N/A N/A Yes CALIFORNIA Agency $29 $29 Yes COLORADO Agency N/A N/A Yes CONNECTICUT Both $50 -­‐ Agency & Ind $50 -­‐ Agency & Ind Yes DELAWARE Both $25 -­‐ Agency & Ind $25 -­‐ Agency & Ind Yes DIST. OF COLUMBIA Agency $25 $25 Yes FLORIDA Both $60 -­‐ Agency & Ind *402 for all counties not including FL fee $60 ($6 per county may apply) -­‐ Agency & Ind *402 for all counties not including FL fee Yes GEORGIA Both $14.84 $14.84 HAWAII* Agency N/A N/A Yes IDAHO Agency N/A N/A Yes ILLINOIS Agency N/A N/A Yes INDIANA Agency N/A N/A Yes IOWA Individual (Agency license optional) Retaliatory Retaliatory Yes KANSAS Agency $5 $5 Yes KENTUCKY Agency $40 $50 LOUISIANA Agency $20 $20 Yes MAINE Both $30-­‐ Agency & Ind $45 -­‐ Agency & Ind Yes MARYLAND Agency N/A N/A Yes MASSACHUSETTS Agency $75 $75 Yes MICHIGAN Both $5 -­‐ Agency & Ind $5 -­‐ Agency & Ind Yes MINNESOTA Both $30 $30 Yes MISSISSIPPI Both $25 $25 Yes MISSOURI Agency N/A N/A Yes MONTANA Agency N/A N/A Yes NEBRASKA Both Retaliatory Retaliatory Yes NEVADA Agency $15 $15 Yes NEW HAMPSHIRE Both $25 -­‐ Agency & Ind $25 -­‐ Agency & Ind Yes NEW JERSEY Agency $25 $25 Yes NEW MEXICO Both $20 $20 Yes NEW YORK Agency N/A N/A Yes NORTH CAROLINA Both $10 life + $10 health $10 life + $10 health No NORTH DAKOTA Both $10 -­‐ Agency & Ind $10 -­‐ Agency & Ind Yes OHIO Both $15 life + $15 health -­‐ Agency & Ind $15 life + $15 health -­‐ Agency & Ind Yes OKLAHOMA Both $30 -­‐ Agency & Ind $30 -­‐ Agency & Ind Yes OREGON Agency N/A N/A Yes PENNSYLVANIA Both N/A N/A No RHODE ISLAND Individual (Agency license optional) N/A N/A Yes SOUTH CAROLINA Both N/A N/A Yes SOUTH DAKOTA Both $10 -­‐ Agency & Ind $20 -­‐ Agency & Ind Yes TENNESSEE Individual (Agency license optional) $15 $15 Yes TEXAS Agency $10 $10 Yes UTAH Agency N/A N/A Yes VERMONT Individual (Agency license optional) $60 $60 Yes VIRGINIA Both $10 -­‐ Agency & Ind $10 -­‐ Agency & Ind Yes WASHINGTON Agency $20 $20 Yes WEST VIRGINIA Agency $25 $25 No WISCONSIN Individual (Agency license optional) $16 $40 Yes WYOMING Both $15 -­‐ Agency & Ind $15 -­‐ Agency & Ind Yes Updated 5/23/17 APPOINTMENT CONTRACT INSTRUCTIONS TO BECOME APPOINTED & CONTRACTED WITH COMPANION LIFE INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.COMPANY:

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting ActThis notice is for your information and does not require any action on your part. PP04 ST-905 Standard Life and Accident Insurance Company I American National Life Insurance Company of Texas Marketing Office: 0000 Xxxxx Xxxxx Xxxx., as amendedXxxxx 000 X Xxxxxx Xxxx, provides that any consumer reporting agency may furnish a consumer report in accordance with XX 00000 I Phone: 000.000.0000 I Fax: 000.000.0000 INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any Virginia Bureau Insurance Code. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant pertinent Administrative Letters may be acquainted or who may have knowledge concerning any such items located via the Bureau of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtainedwebsite at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy print corporate name & principal of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Namecorporation.) (Applicant's Signature) (Date) (Social Security NumberNumber / Tax ID Number Branch Office Number (If known) Form 4708 Rev. 09/07 AMERICAN NATIONAL ALDVA ST-1061 R0815 License & Appointment Fees STATE REQUIRED Licenses for Agency Appointments (Agency/Indvididual) Appointment Fee NR Appointment Fee Simultaneous Submission ALABAMA Both $40 , Agency & Ind $40 , Agency & Ind Yes ALASKA Agency N/A N/A Yes ARIZONA Agency N/A N/A Yes ARKANSAS Both N/A N/A Yes CALIFORNIA Agency $29 $29 Yes COLORADO Agency N/A N/A Yes CONNECTICUT Both $50 , Agency & Ind $50 , Agency & Ind Yes DELAWARE Both $25 , Agency & Ind $25 , Agency & Ind Yes DIST. OF COLUMBIA Agency $25 $25 Yes FLORIDA Both $60 , Agency & Ind *402 for all counties not including FL fee $60 ($6 per county may apply) , Agency & Ind *402 for all counties not including FL fee Yes GEORGIA Both $14.84 $14.84 HAWAII* Agency N/A N/A Yes IDAHO Agency N/A N/A Yes ILLINOIS Agency N/A N/A Yes INDIANA Agency N/A N/A Yes IOWA Individual (Agency license optional) Retaliatory Retaliatory Yes KANSAS Agency $5 $5 Yes KENTUCKY Agency $40 $50 LOUISIANA Agency $20 $20 Yes MAINE Both $30, Agency & Ind $45 , Agency & Ind Yes MARYLAND Agency N/A N/A Yes MASSACHUSETTS Agency $75 $75 Yes MICHIGAN Both $5 , Agency & Ind $5 , Agency & Ind Yes MINNESOTA Both $30 $30 Yes MISSISSIPPI Both $25 $25 Yes MISSOURI Agency N/A N/A Yes MONTANA Agency N/A N/A Yes NEBRASKA Both Retaliatory Retaliatory Yes NEVADA Agency $15 $15 Yes NEW HAMPSHIRE Both $25 , Agency & Ind $25 , Agency & Ind Yes NEW JERSEY Agency $25 $25 Yes NEW MEXICO Both $20 $20 Yes NEW YORK Agency N/A N/A Yes NORTH CAROLINA Both $10 life + $10 health $10 life + $10 health No NORTH DAKOTA Both $10 , Agency & Ind $10 , Agency & Ind Yes OHIO Both $15 life + $15 health , Agency & Ind $15 life + $15 health , Agency & Ind Yes OKLAHOMA Both $30 , Agency & Ind $30 , Agency & Ind Yes OREGON Agency N/A N/A Yes PENNSYLVANIA Both N/A N/A No RHODE ISLAND Individual (Agency license optional) N/A N/A Yes SOUTH CAROLINA Both N/A N/A Yes SOUTH DAKOTA Both $10 , Agency & Ind $20 , Agency & Ind Yes TENNESSEE Individual (Agency license optional) $15 $15 Yes TEXAS Agency $10 $10 Yes UTAH Agency N/A N/A Yes VERMONT Individual (Agency license optional) $60 $60 Yes VIRGINIA Both $10 , Agency & Ind $10 , Agency & Ind Yes WASHINGTON Agency $20 $20 Yes WEST VIRGINIA Agency $25 $25 No WISCONSIN Individual (Agency license optional) $16 $40 Yes WYOMING Both $15 , Agency & Ind $15 , Agency & Ind Yes Updated 5/23/17 APPOINTMENT CONTRACT INSTRUCTIONS TO BECOME APPOINTED & CONTRACTED WITH COMPANION LIFE INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.COMPANY:

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current cur rent or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.)

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting ActThis notice is for your information and does not require any action on your part. PP04 ST-905 Standard Life and Accident Insurance Company An Oklahoma Corporation Marketing Office: 0000 Xxxxx Xxxxx Xxxx., as amendedXxxxx 000, provides that any consumer reporting agency may furnish a consumer report in accordance with Xxxxxx Xxxx, XX 00000 Phone: 000.000.0000 Fax: 000.000.0000 INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relatesme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, consultants, and other licensees), Administrative Letter 2002-9 (discusses what activities require agents/agencies to be licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in the Virginia Bureau Insurance Code. In accordance with that provisionThe referenced Administrative Letters and other pertinent Administrative Letters may be located via the Bureau of Insurance website at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, please print corporate name & principal of corporation.) Social Security Number / Tax ID Number Branch Office Number (If known) ALDVA ST-1061 R3/08 Resident State Fee Non- Resident License # Expiration Date  AL $30.00   AZ N/A   FL $60 per county appt. fee may also apply   IL N/A   IN $20.00   KY $50.00   LA $20.00   MI $5.00   MO N/A   MS $25.00   NE $8.00   OK $30.00   PA $15.00   TN $15.00   TX $10.00 per line   VA $12 per line   WV $25.00   WY $15.00  TOTAL AMONT =$ NAME: CREDIT CARD #: EXPIRATION DATE: CVV: By signing below, I authorize Patriot Health to charge the person signing this form as "Applicant" hereby authorizes any person or agency to give, above credit card for my appointment fees in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing the amount of $ Signature: @ - Fee is retaliatory based on the Applicant's credit worthinesscompany state of domicile MARKETER AGREEMENT THIS AGREEMENT is made and entered into this day of , credit standing2013 (the “Effective Date”) by and between PATRIOT HEALTH, credit capacityINC. a Delaware corporation with administrative offices at 000 Xxxxxx Xxx, characterSyosset, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. NY 11791 (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as hereafter “Company”) hereby appoints its GENERAL AGENT ), and , a company located at (hereafter “GA” or “youMarketer”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.Phone number Fax number E-mail address:

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current cur rent or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 STATEMENT OF POLICY ON PRODUCER DEVELOPED ADVERTISING AMERICAN NATIONAL INSURANCE COMPANY GALVESTON(Company) INDEPENDENT MARKETING GROUP (IMG) GENERAL ADVERTISING GUIDELINES Agents, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) Brokers, Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the authority and obligations set forth in this Agreement, and you accept your appointment subject Company through IMG are required to secure written Home Office approval prior to the terms use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and conditions prospective agents. Detailed Advertising Guidelines are available on IMG’s web site xxx.xxx.xxxxxxxx.xxx, Compliance Issues, Field Reference Manual, Compliance Section. The Company must review and approve any advertisement that: · Refers to the Company · Refers to the Company’s industry ratings and/or financials · Refers to any Company product · Refers to policy or operational/administrative procedures of this Agreement the Company · Describes features of a Company product, or the features of any product, in such detail that it can be identified as a Company product · Targets current or potential agents (recruiting ads) if the advertisement has any of the features listed above · Is attached to or a part of any mailing or distribution of an approved Company ad · Is used on any web site · Is used in the State of Florida that could result in the sale of ANICO products whether or not the Company name or its products are mentioned. WHERE TO SUBMIT ADVERTISING Agents, Brokers and all related Schedules other Producers should submit advertisements to their Marketing Organization for review, approval and Supplements related forwarding to itthe appropriate IMG marketing representative. Registered Representatives of Broker- Dealers should submit advertisements to their Broker-Dealer. The Broker-Dealer should forward such advertisements, including any developed by the Broker-Dealer, to the NASD for review if applicable. Once reviewed by the NASD, the Broker-Dealer should forward such advertisements to the appropriate IMG marketing representative, along with the NASD comment letter.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 *AGENT* STATEMENT OF POLICY ON PRODUCER DEVELOPED ADVERTISING AMERICAN NATIONAL INSURANCE COMPANY GALVESTON(Company) INDEPENDENT MARKETING GROUP (IMG) GENERAL ADVERTISING GUIDELINES Agents, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) Brokers, Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the authority and obligations set forth in this Agreement, and you accept your appointment subject Company through IMG are required to secure written Home Office approval prior to the terms use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and conditions prospective agents. Detailed Advertising Guidelines are available on IMG’s web site xxx.xxx.xxxxxxxx.xxx, Compliance Issues, Field Reference Manual, Compliance Section. The Company must review and approve any advertisement that: · Refers to the Company · Refers to the Company’s industry ratings and/or financials · Refers to any Company product · Refers to policy or operational/administrative procedures of this Agreement the Company · Describes features of a Company product, or the features of any product, in such detail that it can be identified as a Company product · Targets current or potential agents (recruiting ads) if the advertisement has any of the features listed above · Is attached to or a part of any mailing or distribution of an approved Company ad · Is used on any Web site · Is used in the State of Florida that could result in the sale of ANICO products whether or not the Company name or its products are mentioned. WHERE TO SUBMIT ADVERTISING Agents, Brokers and all related Schedules other Producers should submit advertisements to their Marketing Organization for review, approval and Supplements related forwarding to itthe appropriate IMG marketing representative. Registered Representatives of Broker-Dealers should submit advertisements to their Broker-Dealer. After such review, advertisements should be submitted to IMG for review.

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required ! INDEPENDENT MARKETING SOLICITOR APPOINTMENT !" In consideration of my appointment by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that company (“American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “CompanyNational”) to solicit applications for American National, I hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.agree:

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 STATEMENT OF POLICY ON PRODUCER DEVELOPED ADVERTISING AMERICAN NATIONAL INSURANCE COMPANY GALVESTON(Company) INDEPENDENT MARKETING GROUP (IMG) GENERAL ADVERTISING GUIDELINES Agents, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) Brokers, Marketing Organizations, Broker-Dealers, Registered Representatives of Broker-Dealers and other Producers appointed with the authority and obligations set forth in this Agreement, and you accept your appointment subject Company through IMG are required to secure written Home Office approval prior to the terms use of all advertising or promotional materials not furnished by the company. These materials include any advertisement that is targeted to clients, potential clients, current agents and conditions prospective agents. Detailed Advertising Guidelines are available on IMG’s web site xxx.xxx.xxxxxxxx.xxx, Compliance Issues, Field Reference Manual, Compliance Section. The Company must review and approve any advertisement that: · Refers to the Company · Refers to the Company’s industry ratings and/or financials · Refers to any Company product · Refers to policy or operational/administrative procedures of this Agreement the Company · Describes features of a Company product, or the features of any product, in such detail that it can be identified as a Company product · Targets current or potential agents (recruiting ads) if the advertisement has any of the features listed above · Is attached to or a part of any mailing or distribution of an approved Company ad · Is used on any Web site · Is used in the State of Florida that could result in the sale of ANICO products whether or not the Company name or its products are mentioned. WHERE TO SUBMIT ADVERTISING Agents, Brokers and all related Schedules other Producers should submit advertisements to their Marketing Organization for review, approval and Supplements related forwarding to itthe appropriate IMG marketing representative. Registered Representatives of Broker-Dealers should submit advertisements to their Broker-Dealer. After such review, advertisements should be submitted to IMG for review.

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, forms and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial financial information, including information about transactions with other financial financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that This notice is for your information and does not require any consumer reporting agency may furnish a consumer report in accordance with action on your part. PP04 ST-905 Standard Life and Accident Insurance Company I American National Life Insurance Company of Texas INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (RulesGoverningMilitarySalesPractices)found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any theVirginiaBureauInsuranceCode. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant pertinent Administrative Letters may be acquainted or who may have knowledge concerning any such items located via the Bureau of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtainedwebsite at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy print corporate name & principal of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Namecorporation.) (Applicant's Signature) (Date) (Social Security Number / Tax ID Number Branch Office Number(Ifknown) ALDVA ST-1061 R0815 PRODUCER AGREEMENT Producer’s Name: Producer Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.: Date

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, forms and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that This notice is for your information and does not require any consumer reporting agency may furnish a consumer report in accordance with action on your part. PP04 ST-905 Standard Life and Accident Insurance Company I American National Life Insurance Company of Texas INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relates. In accordance with that provisionme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, the person signing this form as "Applicant" hereby authorizes any person or agency to giveconsultants, in writingand other licensees), orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected Administrative Letter 2002-9 (discusses what activities require agents/agencies to be used or collected licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (RulesGoverningMilitarySalesPractices)found in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any theVirginiaBureauInsuranceCode. The referenced Administrative Letters and other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant pertinent Administrative Letters may be acquainted or who may have knowledge concerning any such items located via the Bureau of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtainedwebsite at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy print corporate name & principal of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Namecorporation.) (Applicant's Signature) (Date) (Social Security Number / Tax ID Number Branch Office Number(If known) ALDVA ST-1061 R0815 PRODUCER AGREEMENT Producer’s Name: Producer Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to the terms and conditions of this Agreement and all related Schedules and Supplements related to it.: Date

What Information We Collect. As is an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; , claims processing; , reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting ActThis notice is for your information and does not require any action on your part. PP04 ST-905 Standard Life and Accident Insurance Company An Oklahoma Corporation Marketing Office: 0000 Xxxxx Xxxxx Xxxx., as amendedXxxxx 000, provides that any consumer reporting agency may furnish a consumer report in accordance with Xxxxxx Xxxx, XX 00000 Phone: 000.000.0000 Fax: 000.000.0000 INSURANCE ACTIVITIES REQUIRING PERSONS TO BE LICENSED IN VIRGINIA Per the written instructions request of the consumer Virginia Bureau of Insurance, I hereby certify, under penalty of perjury under the laws of the State of Virginia, that I have received, read, and understand the information provided to whom it relatesme in reference to the Administrative Letter 2002-8 (discusses the many changes in Xxxxxxxx xxxx governing the licensing and other activities of insurance agents, consultants, and other licensees), Administrative Letter 2002-9 (discusses what activities require agents/agencies to be licensed and what activities are and are not permitted for those who are not licensed as insurance agents), and Administrative Letter 2008-03 (Rules Governing Military Sales Practices) found in the Virginia Bureau Insurance Code. In accordance with that provisionThe referenced Administrative Letters and other pertinent Administrative Letters may be located via the Bureau of Insurance website at: xxxx://xxx.xxxxxxxx.xxx/division/boi/webpages/boiadminltrsforagents.htm Date By (Signature) Print Name (If corporation, the person signing this form as "Applicant" hereby authorizes any person or agency to giveplease print corporate name & principal of corporation.) Social Security Number / Tax ID Number Branch Office Number (If known) ALDVA ST-1061 R3/08 ABSOLUTE ASSIGNMENT OF COMMISSIONS CITY OF COUNTY OF STATE OF For good and valuable consideration, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode receipt of living which is used or expected hereby acknowledged, I hereby sell, assign and transfer unto , absolutely and irrevocably, all my rights, title and (Assignee) interest in and to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, all first year and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, renewal commissions now due or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives in the future become due to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For Californiame, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT American National Insurance Company (hereinafter designated as “Company”) hereby appoints its GENERAL AGENT (“GA” or “you”) with the authority and obligations set forth in this Agreement, and you accept your appointment subject to under the terms and conditions provisions of a certain Agency Contract entered into between Standard Life and Accident Insurance Company and me, dated, , and any and all prior and supplemental contracts, if any. Standard Life and Accident Insurance Company is hereby irrevocably authorized and empowered to pay over to the said any and all first year or renewal commissions (Assignee) which are now due or which may become due under said contracts. It is expressly agreed by and between the undersigned and the said assignee that this agreement is made subject to and shall be subordinated to any and all indebtedness by me to the said Standard Life and Accident Insurance Company, previously or hereafter incurred. And it shall be subject to all terms and provisions of said written Agency Contracts and other contracts which are hereby referred to and made a part hereof; and said assignee evidences their (its) agreement thereto by acceptance of this Agreement assignment. It is understood and all related Schedules agreed that by giving its consent to the making of this assignment, Standard Life and Supplements related to it.Accident Insurance Company does not thereby guarantee its validity. IN WITNESS WHEREOF, I have hereunto set my hand this day of , . WITNESS: (Assignor) SSN# (Assignor) ACCEPTANCE OF ASSIGNMENT: SSN# or Tax ID (Assignee) (Assignee) CONSENT TO THE ASSIGNMENT STANDARD LIFE AND ACCIDENT INSURANCE COMPANY BY:

What Information We Collect. As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions. What Information We Disclose We do not disclose nonpublic personal information about our current or former customers to any non-affiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud. Our Privacy Protection Procedures We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. 4977 (5/01) AUTHORIZATION Required by The Fair Credit Reporting Act The Federal Fair Credit Reporting Act, as amended, provides that any consumer reporting agency may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates. In accordance with that provision, the person signing this form as "Applicant" hereby authorizes any person or agency to give, in writing, orally, or in any other form, to American National Insurance Company or its designated representatives any information gathered or maintained by a consumer reporting agency bearing on the Applicant's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the Applicant's eligibility for credit, employment or any other purpose authorized under Section 604 of the Act. Further, the Applicant understands that American National Insurance Company may, as part of its normal procedure, request that an investigative consumer credit report be made whereby information on the Applicant's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with business associates, employers, friends, neighbors and others with whom the applicant may be acquainted or who may have knowledge concerning any such items of information. The Applicant authorizes the individual or agency conducting the investigation to give, in writing, orally, or any other form, to American National Insurance Company or its designated representatives any information gathered or obtained during this investigation pertaining to Applicant's production, persistency, commissions, earnings, estimated future earnings, commission advances loans, and debts, including, but not limited to, any indebtedness that may have been charged to the Applicant's manager or agency, or which may have been written off. The Applicant authorizes American National Insurance Company or its designated representatives to use the reports furnished in accordance with this authorization in any deliberations which it or they may undertake to determine whether or not American National Insurance Company will make an offer of a contract to the Applicant. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. For California applicants only, if public record information is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information unless you check this box waiving your right to obtain a copy of the report. (Applicant's Printed Name) (Applicant's Signature) (Date) (Social Security Number) Form 4708 Rev. 09/07 AMERICAN NATIONAL INSURANCE COMPANY GALVESTON, TEXAS GENERAL AGENT’S AGREEMENT ! *AMLTRN* American National Insurance Company (hereinafter designated as “Company”ANICO) hereby appoints its GENERAL AGENT Independent Marketing Group (“GA” or “you”IMG) IMG Web Site: xxx.xxx.xxxxxxxx.xxx ANTI-MONEY LAUNDERING COMPLIANCE (AML) Effective May, 2006, ANICO implemented an AML program to comply with the authority federal anti-money laundering regulations for insurance companies. The regulations apply to all individual life insurance and obligations set forth in this Agreementannuities (includes individually sold group products), individual registered life insurance and annuities, and you accept your group registered variable annuities. As a result, in order to obtain an appointment subject with ANICO, all producers are required to provide proof that they have completed basic AML training within the terms last 12 months that is acceptable to ANICO, and conditions of this Agreement and all related Schedules and Supplements related they are required to itcomplete ANICO's Company-Specific training course. Producers will be required to receive periodic AML training in order to maintain their appointment.