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Standard Agent Application Information Sheet

M1086- Standard (R-2/2015) Standard Agent Application Information SheetThis page is an instructional page that will assist you in completing the Application for an Agent Agreement or General Agent Agreement,as applicable with Allianz contracting and appointment process does not begin until the following requirements are received. Incomplete Information willdelay the contracting and appointment process. Complete, sign and date the Agent Application and the consent to Background Investigation form. Provide verification of completed AML training. (If using LIMRA there will be an automatic feed to Allianz Life Insurance ) Provide a copy of your E & O coverage certificate with a minimum $1 million in coverage Provide continuing education certificates in states that require this training.

M1086-Standard Page 3 of 6 (R-2/2015) Background information Please respond to all questions for you personally and any organization over which you have exercised control. If you answer “yes” to any questions, you must attach a signed and dated explanation with all relevant information, including dates and supporting documents such as copies of documented …

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Allianz Life Insurance Company PO Box 59060 …

appoint.cmsmenu.com

Agent Agreement 1. Appointment Allianz Life Insurance Company of North America (the Company) has appointed you as its agent/broker (Agent, you or your) to

  Company, Life, Insurance, North, America, Allianz, Allianz life insurance company of north america, Allianz life insurance company

Anti-Money Laundering Training For Agents*

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DM-1039.Rev.3.15 4 Agents must also employ the following procedures under National Western’s Anti-Money Laundering Compliance Program: A. VERIFICATION OF IDENTITY (“KNOW YOUR CUSTOMER ”) National Western relies on its agents to verify the identity of its customers.

  Training, Programs, Money, Anti, Laundering, Anti money laundering training for

Instructions for reviewing and completing the Disclosures ...

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Disclosure Regarding Background and Credit Checks per California Law Additional State Law Notices New York Article 23A Acknowledgment and Authorization for Background Investigation: This page needs to be signed and dated and returned to the Company. Background Information: This page needs to be filled out completely and returned to the Company.

  Background, Disclosures, For background

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