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Insurance Professional Application

Our objective at the Retirement Education and Resource Center of North America, Inc. (RERCNA) is transparency of individuals that meet and represent the opinions and guidelines within Positioning 4 Retirement, allowing the reader a basis for selecting a team of professionals.

By completing and signing this application, it allows RERCNA an opportunity to contact and discuss your professional and personal character as presented in your answers to the questions. You agree to hold Positioning 4 Retirement and its entities and administrators harmless of incident or issues that may arise due to the completion of this application.

Fields marked with * are required.

GEOGRAPHICAL PREFERENCE
Please list at least one area you would like to represent.


CONTACT INFORMATION
Please include attorney's full name.
Please include attorney's full name.
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Please include business address
Please include office phone number.
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Please enter a valid email address
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PROFESSIONAL INFORMATION
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If you have a general agent, please list:
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FIRM INFORMATION
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If you are a member of a firm, how many of the following are in your firm?
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ONGOING EDUCATION AND LEVELS OF ACHIEVEMENT
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PRODUCT REPRESENTATION AND FOCUS
Please breakdown each line of insurance you represent by volume. (For example: Life Insurance: Term 10%, UL 90 %, Whole 0%; Annuities: Deferred 50%, Indexed 20%, Immediate 30%, Variable 0%.)
Life Insurance
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Disability
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Life Insurance
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Annuities
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If yes, complete an additional application as an - Investment Professional.”
If yes, considering the total volume of business your practice performs, what is the percentage breakdown of the following (the total should equal 100%):
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YOUR TEAM OF PROFESSIONALS
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It is not necessary for you to have an assembled team; however, if you have a team or a partial team, we would like to know.
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DISCLAIMER
It is RERCNA’s objective to seek transparency within the individuals that meet and represent the opinions and guidelines within the book, Positioning 4 Retirement, allowing the reader a basis for selecting a team of professionals.

By checking the agreement below, you allow RERCNA to contact and discuss your professional and personal character as presented in your answers to the above questions. You also agree to hold RERCNA, its affiliates, website partners, publication partners, and other team members harmless from and against any loss, incidental, special or consequential damage, liability, cost, or expense for any negligent or wrongful act or omission or misrepresentation by RERCNA relating to the information from this application or any of its links including, without limitation, reasonable attorney’s fees.
You must verify that you agree to the terms and conditions by checking this box to proceed.

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