AGENCY CONTRACT REQUEST FORM

Name: _____________________ FTC #: _____________________

Position Applied: Branch: _____________________

Pre-FTC Date: _____________________ Pre-FTC Conducted By: _____________________

Did you received information about...?

YES/NO

 History of Life Insurance ________

 History of EFU Life Assurance ________
 Sales Career path ________
 Commission Structure ________
 Product Knowledge ________
 Prospecting ________
 Project 25 ________

Applicant’s Signature: ________________ Date: _______________

Location Manager’s Signature: ________________ Date: _______________

(FOR HEAD OFFICE USE ONLY)

Agency Code #: ________________________ Date of Issue: ________________________

Agency Code Issued By:____________________ Remarks: ________________________

SA/3/048 – 1 – 1/1