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LS-0316 ST 10/08 LifeSecure Insurance Company – Brighton, MI Policy Series LS-0002
LifeSecure Agent Appointment
For Agent Use Only. Not For Solicitation Purposes
Step 1 Agent QUICK Appointment Quick Appointment Process
One page Appointment Process with proof
of LTC CE at the time of Quick Appointment
Agent 6-digit writing number & access to
Agent Portal
180 days to submit 1st LTC application
Upon submission, full agent appointment
package is required
Agent commissions may be delayed if full
appointment paperwork is not received in a
timely manner
Quick appointment is not available in the
following state(s): NM & PA. Also not
available when submitting a Worksite or
Group/Association case
For Agent Use Only. Not For Solicitation Purposes
Step 2 Agent FULL Appointment
Agent Appointment Checklist
LifeSecure Agent Appointment Application
Commission Schedule “Exhibit 3”
Distribution Partner Hierarchy Form
LifeSecure Selling Agreement
ACH w/void check or deposit slip
Personal IRS W-9 Form
Assignment of Commissions Form, if
applicable
Copy of ACTIVE insurance license(s)
Copy of LTC CE training & partnership
training, according to state regulations
For Agent Use Only. Not For Solicitation Purposes
Agent Appointment Application – Page 1
Agent Appointment Application
This is a 5 page document
There are questions requiring your response on pages 1, 2, 3 & 5
Here on page 1 your MGA/Distribution Partner may pre-fill their information
For Agent Use Only. Not For Solicitation Purposes
Agent Appointment Application – Page 2
Agent Appointment Application
On page 2 please be sure to complete the “Licensing Information” section
You may be appointed in up to 3 states at initial appointment
Copies of ACTIVE insurance licenses are required for each state
New states may be added with the submission of business and a copy of an active insurance license in that state, plus the state required LTC CE training/ partnership training
For Agent Use Only. Not For Solicitation Purposes
Agent Appointment Application – Page 3
Agent Appointment Application
On page 3 please be sure to complete the “General Information” section
For Agent Use Only. Not For Solicitation Purposes
Agent Appointment Application – Page 5
Agent Appointment Checklist
Page 5 requires the agent’s signature
For Agent Use Only. Not For Solicitation Purposes
Agent Commission Schedule
Agent Commission Schedule
Provides selling agent commission information
Please note: the different commission levels based upon applicant age, premium payment method and client type – Individual vs. Multi-Life clients
States can have specific guidelines
For Agent Use Only. Not For Solicitation Purposes
Distribution Partner Hierarchy Form
Distribution Partner Hierarchy
Provides Distribution Partner organization hierarchy information
This form and information is provided by your distribution partner and is used to place you (the writing agent) within the organization hierarchy
For Agent Use Only. Not For Solicitation Purposes
LifeSecure Agent Selling Agreement – Page 1
LifeSecure Selling Agreement
The selling agreement is 13 pages in length. The selling agreement outlines the obligations and responsibilities of both the agent and LifeSecure
Agents must provide information on pages 1 and 8
Here on page 1 agents must provide their personal information, not agency information
For Agent Use Only. Not For Solicitation Purposes
LifeSecure Agent Selling Agreement – Page 8
Agent Selling Agreement
Page 8 requires the agent’s signature
For Agent Use Only. Not For Solicitation Purposes
ACH – Direct Deposit Form
ACH – Direct Deposit Form
LifeSecure pays ALL commissions via electronic fund transfer (EFT)
Please attach a copy of a void check or bank account deposit slip. This is only used to verify routing and account numbers
For Agent Use Only. Not For Solicitation Purposes
W-9 Form
W-9 FORM
The W-9 form is 3 pages in length and requires responses on pages 1 & 3
The W-9 form must be completed by ALL agents, including those agents requesting assignment of their commissions, but remain eligible for the LifeSecure Rewards Program and contests!
For Agent Use Only. Not For Solicitation Purposes
Assignment of Commissions Form
Assignment of Commissions
The “Assignment of Commissions” form is required only when an agent is requesting to assign their commissions to another person or entity.
The “Assignor” is the Agent and the “Assignee” is the person or entity the agent is assigning their commissions to.
For Agent Use Only. Not For Solicitation Purposes
LifeSecure Appointment Process Review!
QUICK
Agent Appointment Process
One page Appointment Process with
proof of LTC CE at the time of Quick
Appointment
Agent 6-digit writing number & access to
Agent Portal within 48 hours
180 days to submit 1st LTC application
Upon submission, a full agent
appointment package is required
Commissions may be delayed if full
appointment paperwork is not received
Quick appointment is not available in the
following state(s): NM & PA
FULL
Agent Appointment Checklist
LifeSecure Agent Appointment Application
Commission Schedule “Exhibit 3”
Distribution Partner Hierarchy Form
LifeSecure Selling Agreement
ACH w/void check or deposit slip
Personal IRS W-9 Form
Assignment of Commissions Form, if
applicable
Copy of ACTIVE insurance license(s)
Copy of LTC CE training/Partnership training,
as required by state
For Agent Use Only. Not For Solicitation Purposes
LifeSecure Agent Compliance Manual
For Agent Use Only. Not For Solicitation Purposes
Questions?
Please contact your Agent Support
Call Center between the hours of
8:30 AM and 6:00 PM (EST)
Toll free: (866) 582-7701
OR (810) 220-8770
For Agent Use Only. Not For Solicitation Purposes