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. If bolng appolnbd nm{esldcnt In Ftodda,@so provldealt counthE
Boldthg b08lnsrs,. Have ouswr reprasnldmorbarNalonalor snyot
ttssubsldhrlr?o y6 tr No ll .yeo,,provlds Etalh' HrvEyousold
nsuranchrough nolhor amsoragencyn thBpat lveyaars?cl Ye! o No lf
ryes,'iprovlde etqllt' Th Vblnl orlms & Contol Aol ot 1s9'l
makog t a crlmlnalottonrB ot ahylcnewhohasbe6ooonvbtod ol
anygdrnlnslelony nvolvlngdbhonElyor a brBaohol trustto wlllfully
sngagsh iho buBlnersol lnsurams.Haye ouv6tbosn Mlctodor
convlcledtanysuchebny?Havo oobegnansdd q
anyothsrcrlmg?Ityeo,plareglvgspgollioss oohargs,
gle,udsdblonandoutoongi
OYos ENoE Yss oN o
. Havt you dt/el. led or bsq| dslardd bqnkrupt? E yss tr No.
Aroyou qlnsolly obllgatsd undff a norFoompots gro(nont rllh any
lnglranoo oqnsny o. sgsnq? E yos E No. Aroyou prB8fily hdebtod o
any Insuranco ompAny r agonoy? nvog o No It ys,r
proddodgtoltsToWhom Nsturgof Debl Amoqnt Paymenl Tgrmc
. Ha6 a dollcleroyolaln b.en mqdo ageln6t 6u tor any past
n6uEnos angqctlons? o y9s tr Nolf Yss,i pfor/k6 dsl6ll6Haw
youeverhad,gr ngyrhavo.Eny Ed.a|. BS,state ax ltensot
oamlrtmonts?Ar 'u currontlyoovorcdby errorSard onlssiongtnsurqnoo?
E yes E NoE &O CatrlgrPolicy EltsollvoDat6
tr Ye o t{o
ErylradonOala. Hsvg ouwar nbd an enorsandgo 86lo,tslalm? Ey.s
ONo. Havo oue{6| bsendleoldlnedya state nBuranoeearlnor ? f,yos
ElNo. Havg guverbesnoaudonodrdlsolplhodof vlglE0ng
protesslonalodool ethtc6 ary organiza n? try6r trNo. Havo qr
ovorbeanoxpgtledr dlrclplhsd ya prcl66stmalrganEallonuolr s
theNA!U? try.. ONo' Aroyouswarg l anyolhet
nlomatlonhetAmorlcrnNsttonalhquld avo n
aEerslngbushossslatlgnshlplthyouand/o( otr oornpany? tt Yo! E No lf
.yee,,,ploasattaqh detauod taloment'T1|.oEonslgnhg hlo ormsB
Appllcanl".horebyd$owledgoshat.lhoy (o not obt8lnln0
thsnse/eppolntmontlthAnrdoanNallohalmtranc onpanyo. th
oleFrrpoEe.lntenttoodnclpally soibnotphc nsurencen ie applloanl.awn
ltoorthat ol relatfue8,nployst'rot employBB,liEvs reoolvsd.sg4
undoEtandndagrogo oomply lthhecontentsl heProducs/s odeof
Conduct,hsAdvotktgOuldglhes,lhoNoll@ot P.lvaoy ottoy nd he company
utd6b Anrt-Mmeysundertngdopidd yAm*cE; Gr6;i
ilA;iirtft;;".Flrthormoro'adl ol thounderolgngdgclar8sor
um5ll/hIrll,rd .ll othrhtretodar oE, ut allo,thoanBwersn fiooaooeot
Inlsappllmllon no.any upplemos lo Itaro ull,complolond rus o
th9bert ofhlsltg| kno{rledgend belgl. In addl gh,
tl|undortlgnedpdolnoallyllolt8 hat hosoolalBoourlty-Ndmbrr Tax
dentltbaon Nurnbern treappltcattoni iiri J6;il ilr;br.for
hoonlllyapplylngor appolnlmontlthAn8rlcrnNs0onatnsuranceompe;y.l,
hsAppllcani, svorsa4oI thrdato ho$,nbelow, copyof hoabovo
tatsnEnlss requfedbybw.I haw aleo Egd, ndoretoo4arrdlgnodEoolv or
AuthorE!floo ofm 470D,undorr6id rh.arh tsntng htr ormano oiir
ttrfr, I il;;i;ii;;t; ril;;jil;atanyttmo,o
Invoedgat!myackgtound,ncludlng ycrgdlt lBt;ry.$qgll!"" t!9l,q!t
tomakow llon cquestloornpsny'somooltlaolthha r6q6onabloorlodl
rtmgoraddltlonat,otad|lro|nE|rlononcarntnghonatut ndscops t ho
nv8llgEllon.
Forn8770Dab Appllcanl
A6v. 0d/08
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AmorlcanNaflonalnsurancEompanyCompany Gulde to Antlllllonoy
LaunderlngAs an h8uranosproducr, ourgkillsaodservloe6
lpouldlBntsachlgvs inanclalEuocgss nd86c{flly.Slnceyouaron h6 mnl
lln6sof a rxJltl.bllllonoBarndu8lry, ouafa Inaunlqueposltlon oiont
lo Esrv ur cllsds, but abo o ssrvlhb ooonlryby hldng prerEntmon8y
aundEdngnd theffrEnchgof armdsldlYlut.To oompUwllhne$, od6ral
nlfmqtByhundo ngrogldatlon8fur In8urancecornpanles,our fsmlly of
compsnles glmplsmnllng dstallod ntl-monoyaunderlngmgmm.Youhavoan
mporlantoh lo plsy o lhatprogrsm, ou mayo{t6nbo In a
crltlcalposlllono obtaln nformallonogardlngrgoustomor,he ouslorneis
ourca f furds ot lheprodudswEll,and $s didome/s ro$on8for
purcharlng nhsularEofiodudThat h r6[hg lndMdjal anrull86 and llto
In8uranc,hCompgnylsnu.moneyaundorlngrogrsmoqulrsoumust
. En8uro het all Informatlonequested n tho produolspdlcadonand
asBodatedocuronts 18accurato nd@mpbl6. tdudng tha UgA PATRIOT c| N.
ficBtlon8nd C-rr6{omrdGntlflcslbnetmcadonorm ordl
noi-vadabhhrEin9sg.' contact the 8pproprlrb Aod{rloncy
Launderlng(AML) compllmo omoor It a cu8tomer laalltaptrvldlng
Informagon. (Soo conlsct Informallonturlhd ln hlEdocum6nt,)-
Rclrdsof Ihl8 nlonnalonmuslbs tstElned glongas S|oconlraot omattE n
forcaatd for fl\,By6arsheroaftar.. Nodf he approprlstsAMLrpmpllanoe
ffcr lf youdelct eny monsy aunderinged flags, ro lrrEl
0|gcompnygandslsrmhE nhether suspldous cllvllyreporl SAR)mustbe lbd
wllh hoU. S. DopartmonlftheTrssury r Enyaggnoyhereol
PooEfblo d FlagA6{tultyfof a @nprel!nalve d ot tdnaga*W
c'/ntsd,theMlL otfrnrdl Anl6.Iicf'n atlo,?8,l)I Th puroha8eot 8
product lhat eppearsto bolnc'onslslenllth a cuElome|,Eeads.
Thepr.nohassa undlngof a produothat appEarEo6xcsd
custofie/8knownncome r lquldnotworttt. Any atlsnpteduusud
fllelhodof paymont, ai|c|isrlyby oqrhor csshgqulvalenls,llchas moly
otd.sgrcarhlercfiockg. Psymsnt t a lEtgeamounlbroken lo
sevrlEmsllgamounla. Lltllor m concm yE c[Slomer or th6performanceof
an hsurancoploduol.btd muohconoEm bout hoEarlyamlnallooeaureaof ie
prodld. Tha rduclams by I dr8lomsr o provldo sondryhgInfomallon,or
lhs ovlelon f hfomatlofl lhat 866ms
flctltlous. Anyolhoracdvltywtldr you hhk 8 susplolous
ANICO lt{LContaetnformatlonRaportSuephlou. AclN y To
YourAMLcatplaDo,ofllcer- You AML ComD[encr ofrbet l$ thellrer{f,nsl
e ot nolllylng ,t'i'O'' l/./tutg. lt youdo nothaw an AlnL
cor'rydf/rfieOlfr4r,til lEWw nry,msfbrylo twort sufddol/adw to
Nll@'s tlol'J|.Con acr Judlth L Reglnl (Judy), AsslEtant
lcBPlg8ldsnt,corpor8te compllano, ChlefCompllancaflhEl tot
Anll.Moneyrwderlng
Of Erln Elllott, Quallly ssuianconalFtMsll: P.o. Bo(
1800,Gd!6slon, 6xrs7756389mProrrej (800)93&5975Fax: (40S)
21-3886Emarr; [email protected]
Typ6oof Psymenb AoaoptadAdei.s ciJsloiriorshat only lh blowhg
lypBs otpsymentmaybg accBpted:. PsrsonEl6eoks ndpB-authodzDdheok
Eymonts.I cash(curencyor coln) n amools le88h{t $1,0m,. eEsh
equlval6nb monoyord6n, calhler's
cheoki,Irsvelelsoheqke,aokdrsltB),- CaBh nd aashgoulvlgtt6ru.r6t
.podsd otho lRg and FInCENon Form Bg)0 t{h6npaymonb
eoehedbythecomparryn 8 ehgletranssrdon or ln tlvo or nors
rohtgdtrnBctloneolsl mola th|n Si0,000.Relatodtransaollonsoccurdng
vrlhln any l2-mon[lperlod would be eggregetsd or
tepoftlngpurpo66svon t Indlviduallyhoy rst l8 han$10,000. Agenle
mey have Indepsndonl
Iponhg oblgslktno and shouldohsck flelrcottp$!"! wobCt6or
add[orC InforndlonJ. It a cuafjomo?tovldesa tonn of
payme,rtahaaEnol pan,'/fl.4 do mt accaPa he prytnont andnow
tha.ppro,,|,!te AML aot',y'hnco ofilcer f Itk In an ',l''ounl
gt0aler han81,0N,Note An en/@ya4 sg&ntor brokarmutt not,
und8/"any cl.c{tmsttncoq &sctoss al|ft In h# tworaedtutptclow
ac,lvLyor rattWs b aheConpany. ta s aheaotg respottglbry of ths
Coflrptoy's AttL ofilcar bds|d|'],lina wl'',lhal a SAR 18 fllod Mth
th Depa' oftquury. Tho AIqL olrlc.r and the Company8rcorohtblbd
from dtsclo'lrrg to tho aganland any olher'parconthata SARhat bem
f,ld.Tio Compqny8nd [s p.oducorssharq En
lmpodaotrosponsbdllyoconply {,lh [| Compeny'8rogram nd
a[appllcEblgntl{rDngy undrlngaw!. A lallurg o do 8o
$rlllcon8tlluteground8 or dlsobllno, up to and
Indudlngtsrmlnallon.n addlllon,vlolsllottof
anll-nronoyauderlnglav{smayexposo hos ssponglblgo
6ubstsntlalsnel!68undEr f6d6rel l6nir.
Form 475For Mo]o dotatlson oschof t,laae lequlromontr, oontacl
thoAML Offlaorot Amorlcon Nsalonal.
0E/08
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AUTHORIZATIONRBquhed yTh6 FalrCrodltRepodlngAct
Tho FsdgralFalrCredltReporthgAcl, as amondodr rovldedhal
anyconsumerrsportlng genoymay umlaha comumar eport n accordancs l$
he fflttenlnstrudlon8 f th consumaro whom t rlatea..In aooordsnc lh
thatprovlslon,he personEignlnghl6 orm aB ?ppllcsnt"hEbysuthorlzs
any pereonor agsnqy o gfue, n wrloog, orally,or h any other fum,
loAmarloanNatlonalnsuranae ompany r lts deElgnatedspreBentatlvesny
ntormsllongatheredot malntalnedby s consumor aporfng agoncy
bearlngon ths Appllcant'scredllworthlness, rdltBtardlng,oredlt
apscity, halactr,gsnoral oputaffon,grsonalfiaracierlstlcs, or node
of llvlngwhlch s u8edor erescted o bs usod or oollsded nwholsor In
part for tho purposeof seNlng as a tactor in astsbllshlng he
Appllcanlhe glbillty or oredlt,dnp,oymantor
anyotherpurposgauthodzed nder Ssc{lon004 off|a
Act.Fudher,h6,qppllcanlfderstandshatAmerlcan atonalnsuranca
ompnymEy, as part of lte normalproceduro, equst hat an lnve8tlga$vg
onsumercleditraportb6 mado wheroby nfofinatlonon tha
Appllcanf6chara 6r, general epuldon,personal lsrsclerlstlcsor mode
of flvlng 16obtainodhrcughpersonalnl6rvblr,gwllhbuslnes8
s8oolates,mployorB,rl6nds,nolghbors nd otherswlthM)omtha
appllcantmay be aoqualnlodor who may have knowladgsclncBming any
such ltems ofInfomatlon. Th Appllcant authorlz6 the lndlyldual or
agcncy aonducdng hsInvostlgatlon glva, n wr ng, orsly, or any olhcr
orm, o AmerlcanNa0onal nauranceCompany r lts
doslgnatedpre8sntatlvseny ntormallon athdodor obtalneddurlngthls
Invo8tlgatonprtalnlng o Appllcanfs prcductlon, perslslsnGy,
ommlsslons,eafidrEs,ostfnabd fuhre
eamlngs,commlslonadvancesoans,andd8bb, hcfudlng,but not llmlted o,
any indcbbdnoss hat may have been chargod o th Appllcanfsmanager
ragenoy, r whlchmay havebeonwdtlenoff.Ihe Apdlcant
authorlzesAmerlcenNatlonalInsuranceCompanyor ib
clslgnatBdraprsEentatlveo u6e he rportsurnl8hd ln aooordanoofth ils
authorlzstlonn anydsllbrallonswhlch lt or hey may undedake o
determlnewhetharof not AmorlcanNatlonalnsuranceCompanyMll mak6an
off6rof a contraol the AppllcsnL
(App[cant'8Prlntod Gm) (Appllcarfo bnaturE)
(Ds) (SooblsooudryNur)
Form 708 Inflmffimffxl Rv. 1.00
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AMERICANNATIONAL NSURANCECOMPANYWhy Dlrect Deposlt?
DllsotDspoElts he ecommendd ethod tpaymeni tcomml3slonso
compensatautproduoors. her rsa number fbenefltso havlng
ouroommbslons aldby DlrootDeposlt.' SECUR/ry- Tranaior s done
elsctronically no extrs dp to th bank o Etsnd n
lnE'CaNVENIENr-V{'i.ywaltforlhomall?Nomorelostohe6l(8,delays,eta.Youroommlsslonswlllbdpoolledevsnthoughyou
may beoul of th offlce or out of lown.' GUARANTEED-nyoutacoount
yFriday ttho pay$ek.' HOWMUCHPAIDFOR HE WEEK-Cd|
1.800-8904504oryourcommlsslonmounl24 ours day
canstartcalllngafler12:00P,M.onTuasday fthepaywsek)lfyou
ohangsbankswhllson DlrectDopoElt, soncourago ou o oontlouscmalntaln
ouro(lotlr|gaccountuntihvocsn ahangbac* accounls n
oulsystms,ThlBwlll ellmlnatg hEned orspeclalchocks
nddolayBInocelvlng oundul dlrestdepo8ltB.PlEassnote hat fyor
choosenot o ussDh6ctDspolli asyourmthodofpaymert, that ho plocduror
repbclng o6tchecl(8ls a nglhy roce$, A"stopprymenfhastobappllodrd
conflrinedbeforshEbst orexlstlng heck anbe 6lE6ud.hlsprocass
Ekosappfoximrtaly2 w6Eks.DlreotDspo8ltsongolthestpsnANlcO's
utomatlonmoessh6lwlllmakotea8leroryou o acc$8 Inbffiatbn
rgldinoyour psymentot aomml8slons.
AUTHORIZATIONGREETSENTORAUTOMATICEPOSIIlauthorL,a
marlcanNationalnGurancsompany ANICO) nd h6bant llsted o
depoanmycommlsslon8o lho accountnamebelow.Thisauthorlty lll remaln
neffoctuntlllhavss n6wauthorlzatlonrcancllellon.
hecompanyoasrvsShcrlght o Inltlate d6blt entrlss or roovery f
sumEdue o ofdltedrles processgdn anor, lf dqtormlndwlthin he
u/ekofihgcrodltentry,
A Volded Check mu3t bo submltted wlth your requegt for Dlroct
Deposit.AOENT ssN#AGENCY# DEPOSITORYMNK)
NAMEADDRESSCHECKINgACCOUNT#--
CITY,STATE, IPSAVINGSACCOUNT#
9 DIoITROUTINO 9DIOITROuTINOMONEYMARKETACCT% TO SAVINCACCT.
(Name s t Eppearsnchecking ccounl) (Nm s l appErs n Eavlngs ccou
t)lf contractlla r submlttodloahonlcallyhrough omofeforms,voldgd
heakhould scannodnd u!'rnlttgdsqnallachmenttoho ll6 oryoumay ax
copy o 409-62'l-3032.tsubmltul|g olded hckby ogplo66
dudoacol/orBheIndloatlngrlglnalllewasubmltledhtough omoroform3nd
lstappllaant'sdms,
EFTPROCEDURESOnco ouhaveBlgnedp, our heck
lllbeautomatlcellyopoellcdnto our hee*lngnd/or
avlng8coounlapproxlmatoly..lw66korom hedgy hoHomoOlflor
ocslvodhoFquost.Youwill eclvg 'DEPOSITADVICbm whlch lll oplaaoour
heck lub. hlsorm lllshowourgroEsnd oipayor hemonlh
ndyear-to-data.It rA,llll8oBhow lhefdeductlons,
cREDtTUNION__%TOCHECKTNGCCT,--
Form4689FotAganlUeeOnly
Rev. 2/06
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AMERICAN NATTONAL NSURANCECOMPANYGALVESTON,IEXASCDNERAL AGENT'S
AGREEMENTAmahanNational
rsunurcoonrpanyhereinafierosigrratedr"Courpoly") creby ppoluts
itsGENERALAGENT ',GA,'orayou')wltb [6 a0thority rdobllgstioN
etfotth n thisA{reemart! lldyou8cc?tyourappolfircntsubjcato fio
erru and onditionrfthlsAgraanart
ndallIrlatcdSalredulcardgupplcmcntsclatedo LEffec-tlvcat".
ThisAgrecmenthallbecorre lfcctivcm lfanyprovisiou
fthcAgrlernentsrow or shall n the .rhurbc n
connictwi66![pt6UiiIiE6fiEifr:arrneiriof hsuancsrulingororder't
sball omdiffedb thecxhntncosssryor corDpliffoe.tis furceuredshafl
uperaedeltpreviouraBlomerltsetwoc(lhopsfti68.OEliEIl,{L AOENT;
dBlldtcirEAgroffiaro offensrfioo ohedur)By:
(gignaturo)@AMERICANNATIONAL NSI,JRANCBOMPANY:
ByTldo:Qs&-*..-
ExecutivoicePresidentIndcprndaltMarkdingCrcupDqte:
BJ,:- (Sigrstur! of Organizadotr eprEsettadve)Submlttod v:-
-F6l6ffiMrrfiFdrgffiFo!)Rccruiter'sPruoullCode#:BBNEFICIARYORECEiVE@MMISSIC*\TSPAYABLB
FTERDEAII (LIMITED 0 ONEINDMDUAL):Name fBeneficieryPristor
Typo)
A[thorlty - You arc herlby ruthodacd to dovclop lndBupowiro ho
onpltry'r brsbclr i$ confoMity with tbcrulccrod rcguhdor8 of tl6
Corrprny. You shall rlcnrli ardrccolisrcud for rppoidE6Dt by tho
ConlDa[y ndivldualr aodsgodci6. q$lilicd lnd expcrienc.d n llft
Innmtrc6 inls .nd.orvicc f,s 0g fr. You r|)|lll tllln snd $peivls6
sr.h lgcrlsin accordlno! l'lth dlo rlr&l6rd! of rio corrpory
ntld th6IsqulrnEnt! of lh. rtslc o. ststesh whlch llEy ftDctiotr
foltbo corlrpllry. You 0ckno1{ledBg lldt sll .8erh iI youlhisrlrchy
lrt indepetrdo contrsolon oflho oompsnytrd, dtI subs8edr elcstion r
!t thc solrdiscrdlor! fdro Cofiprnyoan b9 lraryfcned by |6 Conps[y
h acoorddro wldr thoCoDrpo$y'sn$fer rules.You rhsll sollclt
aprllcatlottr for odllury llfo Ir mnooslda![uitlos to be lssocdby
tll6 Cornprny rod submit ruclrrlpllcationr rcc6lyqd o dro CoNpsly,
provlded hntyo$ 0r!plopo{y lhcdici .r rcquid by rly tovcmmcrfil
lul[orityrppllo|blo to yon, You shsll dcllvff Dollaler lssudbI
drocompuy, oolloct tfio lirlt lrstuluN the]ofor, trflu|lllt
allcollcolloE hnncdlltcly to tho C,onpeny,ond rruto cvotyoffort to
orhlah h forcs all pollcier lssuedby tlle Co[palty,Ford4737
You rlrdl !t sll timec coDply wlth tho ruler nnd rog$htion!of
the CooDdy pcrtrinhg !o urdcrirritihg prar*ioes,monphnooofrirkr,
dclivgryofpolicics, md all oth6r0F6! ofooDdlct of tho Co$p!ny'!
b{siocsr. ftg 'tbtiotrlhhetwBo t! Corlprny lnd yo! plrotsdby d r
Agltdrcrt isthit of sn Indcpordg|rt oontlroto!, rnd rothlng In
ttlsAgllcDort rlsll b! corstrucds. oertlng rbo rll.tim.l||p
of6,q)loJ6r 0nd anploy.c botwoc0thc Con{t.ny and you.Neltlreryor
[or. your orDployosr or agnrs hsll b! deoDdto bo tho smployosor
0eivrnt of$o cotrprty. You sh6ll '!oto full-tlu6 hmtmnocdgcnt i
dcfincd ty thoPodcralSoridlScq|flly Lrw' Noo! of6g brnsfltr
pmvld6dby tho Cornp8rlyto it6 euplo]&cs, iDcludln& bnt not
llDritod to, wo*d,scoffpemstioll tlrur!||cs s[d
urtomploymontn|um||cosrorvsihblo io you, your crllloyor or qgq r.
If tr0idrycouner, rrlae [rtlodr ind urtari8l or slnllar aids
rtrdNervlco! ro oxlend.d or lrlado vaihblc toyo\ lt b r$redtist
thcir purporc nd rffcct dtqll mt bcb givo th! Comp.lycontml oltr
your tltno or dltlction, but only to o$i6t you
inyoilrbu6lncss.Llos|l8iDg f ago||b rhall bo n conplisDeoyrlm $0
sirtutorysndrcguhtory requltlrncot! ofdlo DrpsrImentroflnrurancot
o*t
