CONDITIONS AND AGREEMENTS. I hereby certify that my answers to the questions contained in this application are true and correct. I acknowledge that ReliaStar Life Insurance Company (hereinafter called the “Company”) has informed me of the Company’s practices to conduct routine investigative reports on agents for licensing purposes, initial and renewal state appointments, and at any time the Company, at its discretion, deems it necessary to conduct background investigations. I expressly authorize the Company to conduct these investigations and authorize all persons and entities (including past and present employers) to provide the Company all requested information. I also expressly authorize the Company, for the purpose of facilitating the licensing and appointment process, to share information gathered as a result of these investigations with my agency and/or broker-dealer (including any third parties authorized by my agency and/or broker-dealer). I release from liability all persons and entities which supply said information to the Company and agree to hold the Company harmless from any liability for conducting this investigation. I authorize the Company to use these investigative reports and to provide these reports and any other pertinent information to all ING affiliate companies and to third parties where the third parties’ legal interests and/or obligations are involved. I authorize the Company to share any financial, business, legal, tax or work performance history regarding me that it receives from third parties, from any ING affiliate companies or which is generated by the Company or from the ING affiliate companies’ data source that is not part of the investigative report, with all other ING affiliate companies. I also authorize the Company to share my debt balance information with agents, agencies or other third parties that assume my debt balance responsibilities, as well as debt collection agencies and debt reporting services. I certify that I have reviewed this application and I understand that if any information provided in this application is found to be incorrect or incomplete, it will be grounds for rejecting this application or for termination of my appointment, all in the sole discretion of the company. I agree to read and abide by the Company’s Business Guidelines and other Company policies and procedures, as they may be amended from time to time, located at ▇▇▇.▇▇▇.▇▇/▇▇▇▇▇▇▇▇▇▇▇▇▇ or on the Producer/Distributor Web site (▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇).
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Sources: Contracting Checklist
CONDITIONS AND AGREEMENTS. By signing this Application, I hereby certify that my answers to the questions contained acknowledge and represent that: ⬤ All information furnished by me in this application are true Application is true, correct and correctcomplete. ⬤ I understand that no Company has an obligation to approve this Application and I release any Company that does not appoint or contract me from all liabilities. ⬤ I agree not to solicit or sell, as determined by state law, any business until I have been notified by each checked Company that I have been contracted and I am authorized to solicit or sell business for it. ⬤ I have included a copy of a current license for each state in which I do business. ⬤ I authorize any person or entity that may have knowledge of my employment, financial, criminal or other history to release such information to any Company in connection with this Application. I authorize each Company to release any information regarding my Debit Balance to Vector One, or any successor organization. A photocopy of this authorization will be as valid as the original, regardless of the date it is signed. ⬤ I also acknowledge by my signature below that I authorize the Company, now or in the future, to obtain a consumer and/or investigative consumer report on me, and that I have received from the Company all disclosures required by the Fair Credit Reporting Act. ⬤ I have received and read the Agreements, including specified Compensation Schedules, that are listed below and that are incorporated by reference into this Application. I understand and agree that by my signature below, I am agreeing to all of the terms and conditions of the Agreements, including specified Compensation Schedules, that are listed below. Check Agreement Type: ⬜ General Agent (Order #131419) ⬜ Producer (Order #131420) Check Requested Company Appointments (If new, attach copies of current licenses) ⬜ ReliaStar Life Insurance Company ⬜ ReliaStar Life Insurance Company of New York ⬜ Security Life of Denver Life Insurance Company Indicate Commission Schedule Level Codes1 ReliaStar Life Insurance Company Variable (hereinafter called the “Company”) has informed me For ING Financial Partners General Account Target Compensation Excess/Renewals Term Target Compensation Term Renewals Level Code1 Level Code1 ReliaStar Life Insurance Company of the Company’s practices to conduct routine investigative reports on agents for licensing purposes, initial and renewal state appointments, and at any time the Company, at its discretion, deems it necessary to conduct background investigations. I expressly authorize the Company to conduct these investigations and authorize all persons and entities New York Variable (including past and present employers) to provide the Company all requested information. I also expressly authorize the Company, for the purpose of facilitating the licensing and appointment process, to share information gathered as a result of these investigations with my agency and/or broker-dealer (including any third parties authorized by my agency and/or broker-dealer). I release from liability all persons and entities which supply said information to the Company and agree to hold the Company harmless from any liability for conducting this investigation. I authorize the Company to use these investigative reports and to provide these reports and any other pertinent information to all For ING affiliate companies and to third parties where the third parties’ legal interests and/or obligations are involved. I authorize the Company to share any financial, business, legal, tax or work performance history regarding me that it receives from third parties, from any ING affiliate companies or which is generated by the Company or from the ING affiliate companies’ data source that is not part of the investigative report, with all other ING affiliate companies. I also authorize the Company to share my debt balance information with agents, agencies or other third parties that assume my debt balance responsibilities, as well as debt collection agencies and debt reporting services. I certify that I have reviewed this application and I understand that if any information provided in this application is found to be incorrect or incomplete, it will be grounds for rejecting this application or for termination of my appointment, all in the sole discretion of the company. I agree to read and abide by the Company’s Business Guidelines and other Company policies and procedures, as they may be amended from time to time, located at ▇▇▇.▇▇▇.▇▇Financial Partners General Account Target Compensation Excess/▇▇▇▇▇▇▇▇▇▇▇▇▇ or on the Producer/Distributor Web site (▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇).Renewals Term Target Compensation Term Renewals Level Code1
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