INSURANCE AGENT AGREEMENT BEST DOCTORS INSURANCE LIMITED, INC hereinafter referredto asthe “Company” hereby appoints: Agent Agency: Address: City, Country code: Hereinafter referred asthe Independent Master General Agent (*Master Agent”, “Agent")Best Doctors: NS URANCE INDEPENDENT MASTER GENERAL AGENT AGREEMENT AGENT CODE ‘Best Doctors Insurance Limited, 2 Betmuda company the “Insurance Company"” Company’, and i affites sell major medical insurance products to residents around the worl, excluding the United States of Ameria (USA'). All references tothe Insurance Company shall include by reference all of fe afilates: and this Agreement shall govern al relationships with such alates unless a separate wrtten agreement has been executed by such pares. Independent Master General Agent (Master Agent’ " Agent) & an authorized, Master Agent of insurance products, unafilted with the Insurance Company, who alranges and purchases for hsihelts customers (Customets), who ate residents outside the USA, major medical insurance prodcts that provide such Customers wth access to medical services throughout the world, CONDITIONS FOR APPOINTMENT Master Agent shall have the right to sell the Insurance Company's products so long as Master Agent complies with the terms of this Agreement land meets the production and petsistency goals identfied belaw as have been agreed to by both partes. 2) Starkup. Master Agent shall provide new business to the Insurance Company within ninety (20) days of entering into this Agreement (the “Start-up Requirement) b) Braduction. Master Agent shall eet the annual production goals setforth on Appendic A (the "Production Requitement’) ©) Patsstency. After the fist year ofthis Agreement, Master Agent shal renew polces in each subsequent year to meet the threshold set ‘rth on Append A. based upon aggregate premium value ofthe in force poles in effect atthe end ofthe prior yeat (the “Persistancy Requirement) A) COMPENSATION ‘TERMS OF COMMISSIONS: Rate of Commision "Commission: are as Isted on Appendix Ato this Agreement. In the event that Master Agents allowed by the Insurance Company to receive a Commission onthe sales made by other Master Agents, the approval of such sub-agenoylagent and the terms of such arrangement shall be provided by Master Agent inthe form of Appendix Awich shal Be'approved by the Insurance Company, ints dscreton, fom sme to time ‘Commissions shall only be paid and payable upon the occurence ofthe following conditions: 2) Policies ssued and accepted bythe Insurance Company after ths Agreement s effective ) The Insurance Company has received the full payment for the premium then due (for example, semi-annual obigation) and such payment has cleared and'snomefundable, except in accordance withthe specific terms ofthe policy. ‘All Commissions paid are subject tobe recouped by the Insurance Company for policies cancelled before the expiration date if any premium on the poi returned, incase of rescission of» policy by the Company. ‘The tight to Commissions shall be paid te Master Agent without modification s0 long as the palicy is in force unless Master Agent fa to meet the Production Requitemens listed the Condition for Appointment, in which ease this Agreement may be terminated, cancelled or modified by the Insurance Company: ‘Vesting: The rightto Commissions shall be vested and pa to Master Agentso long a5 the poliy i in force unless 2) The insured/Customer has stated in writing that helshe does not desite to do business with Master Agent and/or requires another Master ‘Agent to be appointed, in which case the Master Agents right on such spectied polcies shall be terminated in full at the Insurance Companys discretion b) Legal testictions or 2 material breach by Master Agent of the terms and conditions herein, in which ease this Agreement may be ‘terminated, eanceled or modtfed bythe Insurance Company’ ©) Master Agent fais to sell atleast one (1) of the Insurance Company’ products every ninety (20) calendar days, in which case ths, Agreement may be terminated, cancelled of made by the Insurance Company: ot 4 Master Agents failure to mect ether the (1) Start-up Requirement of (2) Persistency Requirement each as listed in Conditions for Appointment inwhich ease this Agreement may be terminated, cancelled, o1 modified by the Insurance Company. Master agent agrees that commissions wil not be paid for extra premiums or for premium loadings that could be added during the undenwriting Process, for administative fes, after agent is no longer assigned to a policy of to 2 Agents portoli, the Agent has an impediment which Fenders him/her unable to provide sevvices or assistance to an insured, or helshe urwling t do so. Commission Withholding: The Company reserves the right to withhold commission payments at any given time, wile awaits the result of any investigation of the Agent by the company or any governmental agency or authorty of any jurisdiction forthe alleged improper conduct of sad ‘Agent. Ths provsion Shall net affect The Company's abity to terminate ths Agreement, putsuant the terms herein. Modifications: The Company reserves the right to modify commissions on potcies that have not yet been issued as ofthe elective date of the commissions change. The commissions change shal become effective when communicated ining tothe Master Agent. ‘Taxes: The Insurance Company may requite any Master Agent that resides inthe United States to complete a W-0 (or ather appropriate form) or verty that they afe not subject to United States taxes. Inthe event that any value added tax or general sevvices tax. ot simiar obligations, are oF Shallbe deemed due and owing tothe taxing authety of any jus dicdon pursuantte ths Agreement the parties hereby agree that Master Agent shall be soley responsible for attending to al processes and flings fr which any party may be abe in connection herewith and Master AgenBest Doctors: NS URANCE hall bear the costs of and pay any and all such taxes, costs and fees and shall hold the Insurance Company harmless (including reasonable ‘torneys fees and eoss) in relation tothe same. 410. Currency: All currency Isted in any premium table, policy, reimbursement, or commissions shall bein United States Dallas (S). The Insurance Company shall receive any amount in any eurency ether than United States Dolla. 11. Beneficiay: Ifthe Agent should become incapacitated or des the vested commissions shall be paid tothe beneficiary designated by the Agent ‘The designation s subject to the terms and condtions of ths Agleament. A Beneficiary Designation Foim should be completed and # will become part of ths agreement 12, Assignment Nether this agreement nor any right or obligation hereunder may be assigned by the Master Agent to a third party without the prior witten consent ofthe Company. The Company may assign ths agreement to a subsiday, affliated or related company without prior notice ot Consent. Master agent agiees to perform al acs deemed reasonably necessaty to assist the Company in the assignment including but are nat limited to the execution of documents and assistance of cooperation in legal proceedings. Hf any poviion ofthis agreement hold tobe legal or unenforceable, such provision wil be med or eliminated to the minimum extent necessary s0 that this agreement 8. TERM and TERMINATION 1. Effective Date: Ths Agreement shallbe effective after itis duly signed by or on behalf of the Master Agent and 25 of the date countesigned by an bce ofthe Insurance Company. 2. Term: This Agreement shall remain in force for 2 petiod of one (1) year. which shall renew automaticaly unless notice of non-renewal is given no less than tity (20) daye prior tothe expected renewal tem: provided that this Agreement may be terminated pursuant toe terms inthe event of 2 breach as set forth elscovhere in this Agreement 3. Tetmination: If its determined that () legal testctions would prevent the Insurance Company doing business with Master Agent, or (i) Master ‘Agent has not complied wth all material terms of ths Agreement, then Insurance Company may terminate ths Agreement wih notice to Master ‘Agent, 25 determined inthe sole isceton ofthe Insurance Company. The Company reserves the right to cancel this Agreement i another insuret cancel A agleement wah the Agent due fo fraudulent acs, or the msmanagement of premiums or commissions, as descibed in this agreement. 4. Effect of Termination: Upon termination of this agreement, Master Agent wil immediately cease to promote, matket and procure insureds application forthe products and use af any of the Company matketing materials and as intellectual property (IP) righ. Agent wll So immediately Tetum to the Company or destioy (at Company's option and direction) any and all Company's material in Master Agent's possession. Al Commissions, less any refunds or ofets, due to the agent as ofthe termination of ths agreement will be payable. The provsion under tile Company Regulations leterF) shall survive termination ofthis agreement MISCELLANEOUS 1. Waiver: Forbearance, fale or neglect on the patt of the Company to enforce any oF all ofthe provisions of this Agreement shall not be constiucted as a waiver or estoppel of any ofthe rights or prhileges ofthe Company. AlaWver of a past act o ctcumstances shall nat be deemed 2 course of conduct or waive ofa subsequent actor cicumstances 2. Severability: In the event any provision, clause, sentence, phrase, or word hereof, or the application thereof in any circumstances, is held to be invalid or unenforceable, such invadty or unanfoeabity shall not affect the valid or enforceability ofthe remainder heteot, o ofthe application of Sny such provision, sentence, laure, phrase, or word in any ather circumstances. This Agreement constitutes the ful and complete agreement ofthe Patties with respect to the subject matter hereof and supersedes, cancels, or annus all prior agreements, understandings, and undertakings relating forthe subject matter hereof, and may net be amended except ar oerwise provided for heteinwwthout the express writen consent ofthe parties 3. Amendments: This agreement may not be amended by agent, nor may any obligation of agent be waived, except by mutual agreement ofthe patties. The Company may. at any te by notiying agent in wring amend the products, the rate of commisions or any ether payment to agent the Processes and provedures for quattying palcies and ths agreement. Such amendments will become efectve seven (7) business days thereat Unless agent notifies the Company in wifing of # non-acceptance of the amendments and teimination of ths agieement. Agents continued performance wil constitute acceptance of any amendment 4, Limitation of Liabilty: The Companys abit for any direct damages for any claim at cause of action whatsoever relating tothe agreement shall nat be exceed the total amounts paid fo the agent under this agleement which gave se to the dispute dung the preceding weve (12) months. IN NO EVENT SHALL THE COMPANY BE LIAGLE FOR ANY SPECIAL INDIRECT INCIDENTAL OR CONSEQUIENTIAL DAMAGES, LOSS OF PROFITS, EVEN IF THE COMPANY IS ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. The paries agree that any Higaton claims must be flea within fone yeat from the date such claim gave ree . GENERAL RESPONSIBILITIES 3) Master Agent agrees to provide policy service and assistance to hishet/is Customers atthe level expected ang relayed to Master Agent by ‘the Ingurance Company’ ») Master Agent shall only quote premiums for any Customer pursuant to the cuent premium tables provided by the Insurance Company ot 1 ethene provided bythe Insurance Company in wing ©) Master Agent shall destroy any and all information helshelt has been given by the Insurance Company whenever new, replacement information © provided by the Insurance Company. The f to ensure that the Master Agent aivays has the most accurate information {elated tothe product and current rates. In the event this Agreement i tetminated of not renewed, Master Agent wil promptly return any ‘and allinformation of any natute provided bythe Insurance Company. 4 The Master agent is obigated to be fully Knowledgeable ofthe products offered by The Company. Master Agent shall properly manage. ‘sain and supervise any and all employees, affiates, subordinates, agents, and sub-agens, including any general agents and independent® ® » Best Doctors: NS URANCE agents (collectively, “Sub-Agents?) that work or perform services on behat of Master Agent. Master Agent undetstands and agrees that Master Agent shall be eect responsible for any falure By any such Sub-Agents and shall be held responsible bythe Insurance Company {forthe actions of any such Sub-Agenss: provided thatthe Master Agent shal only be lable forthe acfons of any such Sub-Agents upto the ‘amount ofthe commissions the Master Agent recelved related to the actions of such Sub-Agens. Master Agent has 2 power of attorney (or similar pone!) to select a major meGieal insurance product on behalf of ts Customeis to choose ‘the best insurance product avallable, worldwide, for clent and i speciicaly not obligated, in any fashion, to choose the Insurance ‘Companys product. ‘The Master agents is oblgated to explain his/her customets that international major medical heath insurance products offered by the ‘Company do not necessarily follow the regulations and mandatory coverage requited bythe authorities of ther county of residence: signing ‘the application customers understand and accept the conditions ofthe international health insurance products. Master Agent states that he Ishe has been given the full power to receive and deliver of a polcy on behalf of ts Customers. Master Agents receipt of 2 power of _attomey includes the ight of united substitution by Master Agent forthe person to act as an atnative power of attorney. In addon. in “any event where Master Agent purchases a product from the Insurance Company on beha¥ of Customer, using &s Customers credit ‘eatd or othense, such transactions are being performed by Master Agent soley atthe request and requtement of ts Customer and nat in ‘any fashion, pusuant toa request or requtement ofthe Insurance Company. In any event where Master Agent receives personal heath information of fe clans, Master Agent hereby agrees to maintain the securty and confidentiaty of such information ar required by applicable lan, ‘Sub-Agents: Wotking Relationship between the MGA and Sub-s/Sub-Agents: The MGA i responsible forthe actions and performance of his Sub-Agents, and must provide assistance, support and taining. The MGA shall not withheld commision ot cancel 2 Sub-Agents Agreement, unless authorized in iting by The Company, in accordance with the teims and condone inthis Agreement. The NGA agrees {te elease 2 Sub-Agent who was assigned to him/her by The Company, when that Sub/Agent reaches the following production rato: A portfolio of USS, (annual premium value). When the Sub-Agent obtains the qualfeatons to become a Master General Agent (MGA) {wath The Company, the override commésion payments to his/her former MGA wil cease, with the exception of the policies Sold prir tothe ‘date when the Sub:Agent was feleased JURISDICTION Governing Law Resolution of Disputes. This Agreement shall be governed by and construed in accordance withthe internal laws of the ‘State of Delaware, U.S.A. applicable to contracts made and to be performed entrely with such State, without regard tothe confict of las Diinciples of such Stat. Any depites relating fo this Agreement that cannot be resolved though good fath negotiation between the parties hall be finally resolved by binding aration to be conducted in Boston, MA pursuant to the rules of the International Chamber of Commerce Complaints and Procedures ‘The agent shall conduct his her business in accordance with The Company's regulations, and helshe shall notfy The Company, in wating of any complaint, accusation, proceeding andlor investigation catied out by any authorty against havher, Lkewse, the Agent shall notty ‘The Company about written complaints by the cients, elated to any product or sevice offered by & Notice ‘Any notice hereunder may be delivered in petson or in iting by mal facsimile or electronic mailto your lastknown address. ‘Any notice tothe Company shall be addressed: Best Doctors Insurance 5201 Blue Lagoon Drive, Sute 300, Miami Florida 33128, facsimile: 1-800-476-1160 Emalinfo@bestdoctors.com Indemnification Master Agent agrees to indemnify and hold harmless the Insurance Company, ftom and against any and all costs, losses or damages {incising reasonable attomeye’ fees and costs) of any nature whatsoever ae a resub of Master Agents (or a Sub-Agents) falure 0 roperty perform any of is obligations under this Agreement (ot any agreement ith such Sub-Agens): provided that the Master Agent shall ‘only be lable fr the actions of any Sub-Agents up ta the amount ofthe Commissions the Master Agent received related t tha actons of Such Sub-Agent The Agent shall not involve The Company in any contractual elaanship related to Ms/het personal business. Each Agent Shall hold The Company hatmless, a5 well as its shareholders, partners, associates, membels, decto's, offiets, and emplayees ftom any ‘lains, damages oF lalies/iesponsibilties arsing out of any Such involvement Independent Intermesiary Nothing contained in hi Agreement shall be consttued to constitute a pattnetship or contractual employment between the Insurance Company. ts afilates and Master Agent. and Master Agent shal nat and cannot bind the Insurance Company in any respect. Master Agent hhas no felationship to the Insurance Company. except as an independent, thtd party intermediary Entre Agreement: This agreement, and the exhibis attached hereto, set forth the entre agreement ofthe Partis relating to the subject, ‘matter hereof, supersedes ll rir and contemporaneous communications or agreements writen or oral and is intended by the Parties to be a complete and exclusive statement of the terms of the agreement between them. This agleement may only be modified by a win specially modtying this agreement and signed by both Parties.F. COMPANY REGULATIONS 1. Compliance ‘To the extent required by applicable law or Insurance Company polisies and procedures, Master Agent assumes all obligations to meet and comply with alllaves ofthe ()localies and nations in which Master Agent operates and esides that ae flated to the relationship described in ths Agreement and (i) Unted States, Bermuda and such other counties that impose obligations in connection with the relationship described in this Agreement (eg. U.S. Foreign Corrupt Practices Act Anti Money Laundering avs. OFAC, HIPAA, etc) ‘The Company expects and anticipates that the Agent knows and complies with said laws and regulations, 25 well a with intemational ‘regulations and those ofthe jus ditions where ts olen reside. Master Agent shall take all necessary measures to prevent the purchase fof the Insurance Companys products forthe purpose of money laundering, and shall assist the Insurance Company in investigating any ‘legatons suggesting that an insurance product was purchased of used for money laundeting ‘The Company may request the collaboration ofthe Agent for compliance wih said lans and regulations. One of the Agent's 1esponsibilties '5 that of maintaining the necess ary documentation to camply wth said norms and, wihen needed, delves the documentation in question to ‘The Company. I the information needed or requested not tecelved by The Company in a reasonable petod of time, or # there suspicion of ftaud ot money laundering, The Company eserves the right to reject any transaction requested by the Agent on behatf ofthe ‘hans helshe represent ‘The Company requires and the Agent accepts to receive training for the prevention of moneylasset laundering, US. Foreign Comupt Practices, OFAC, the company Code of Conduct and any ather regulation 2. Information Confdentiaity/Privacy ‘The Agent acknowledges that he may receive information of a non-public nature, 25 well as health information andor personal information about the applicants ot potential insured in accardance with ths Agreement. The Agent, as well as h/her other agents, employees, and Subcontractors shal malntan the integrty ofthe confidartialty of sai information Clent Information), pursuant to the applicable las and equations pertaining to privacy and, additionally. helsherhey shall agree not to use, divulge or in any other way reveal any of the Client Information, other than that which s necessary fo insurance purpeses that ate contemplate inthis Agreement. including but net limed to, }) delivery of an insurance appleation,§) any medical information abovt the heath of an insured or potental meured, or H) financial oF personal information. Any disclosure ofthe Client Information which may be in breach ofthis Agreement shall be notified to The Company ‘thin the fve () days following the moment in which the Agent becomes aware of said disclosure. The Agent shall then defend, indemnity land exonerate The Company from any responsiblity for any loss, cost, settement or judgment, agfeement or covenant fine, assessment of valuation, penaty or other monetary expenses, including reasonable atforneys fees incured by The Company as a dect o indirect resu ‘of the volaton ot breach of hs paragraph by the Agent Master Agent agrees that without the express wrt consent ofthe Insurance Company, Master Agent including any Sub-Agent) wil nt at any ime divulge, funsh, disclose or make accessible to any person, fm, organization or corporation in any manner whatsoever any lopretary or confdental information ofthe Insurance Company. “Confdental normation”inckides, but & not ited to, the Insurance Companys clients, business description data, future development plans, customer prospecs and lists, customer support stiategies, ‘marketing strategies, financial information and pricing pokies. 3. The Company's Property Rights ‘The information and records of the applicant and the inswred, as well as any other premium records are the property of The Compary. ‘Therefore, the Agent shal alow thei inspection by The Company when required. Al printed materia, equipmert and others provided by ‘The Company are also ovned by f, and the Agent wil be legally responsible for thelr misuse, At The Companys request, the Agent ‘obligated to return all premiums for policies not accepted, delvery receipts, receipt of ial premium, condtional receipt and all ‘documentation and information related to The Companys business 4, Utization of informational Technology Applications ‘The Agent hereby agrees to confidentially handle all Informational technology applications or electonie system, of others received by inv from The Company which did nat have the utimate purpose of avthorzed distribution by The Company, a well ax to not divulge, ‘duplicate or reproduce, direct or indtect any such applications of systems. The Agent wil adopt al reasonable measures to avold those rnon-authotized petsons should gain access to sald applications o systems; or that they should divulge or duplicate them. The Agent shall be legally responsible for the losses and damages that may alse fiom the non-abservance of these compromges. The Company can equest fom the Agent, in iting, that helshe return all applications, systems and documents fo hinvher provided by The Company. and helshe shall be obligated to do sa. At the termination ofthis Agreement. subject to verfieation by The Company. the [Agent shall top using Said systems andT applications, and shall remove them from hse fies, (hard ives, potable equipment secutty Unt, ete), and shal Provide them to The Company, after thas inventoried the remaining publieation media (diskettes, USB, CD's, te). 15, Inelectual Property ‘The Agent acknowledges that al maKs, including service, symbols, logos. emblems and other or matting methods, 25 well 35 other tights ‘to tangle or intangible intellectual properties elated tothe insurance actvty conducted by The Company ate is exclsive propery. The ‘Agent shal not acquire any ight over the above-said intellectual property tuough ths Agreement The Agent shall not adopt, use of registjBest Doctors: NS URANCE any key word, phase, symbol orsign used for publicity that might be identical or similar tothe masks symbols or maiketing slogans of The ‘Company. Nonetheless, the use, form of display of such mass, symbol of slogans of The Company. used in the exerese ofthe activity of ‘the Agent shall be subject tothe prior approval, in wring, by The Company. The Agent is obligated to only use the sales formats or proporats ieeved by The Company and related to the promotion and sales of The Company's polities. The Company shall provide to the [Agent the matketing material t deems pertinent forthe promotion of ts products and services ‘The Agent may use maiketing materials generated by hinher forthe effect ofthis Agreement, such materials ate authorized, in writing, by The Company, All use ofthe tadematks of the Insurance Company by Master Agent will nure to and be forthe beneftof the respective holder or owner ‘heteot (ether the Insurance Company of an afliatethereo?), and Master Agent shal have no right of goodwil associated with any such ‘uademats. The Master Agent shall have the right to use any ofthe trademaks of the Insurance Company upon the advance, witen ‘consent of the Insurance Company and only in compliance with the trademad usage qudelnes ofthe Insurance Company. Master Agent vil discontinue all use of such trademafis and service maks upon expiration or termination of this Agreement for any reason oF upon ‘writen notice to the Master Agent from the Insurance Compary. Master Agent shall have no right to advertse using the Insurance ‘Company tradematks tothe general publ, exceptfor notice materials that are generally available at Master Agents offices 6. PROHIBITED ACT: 2) Master agent declares: 1. twill not deposit cash forthe payment ofthe premiums or renenals ot negotiate any chedks or other nancial instruments payable to The Company. nor wil | open any bark accouns in The Company's name, of sigh, under any circumstances, in The Company's name, ot have checks, promissory notes of other fnancial instrument generated that may contain The Companys name, I wil ot retain payment of the premiums under any ercumstancer, and wilfnward them to The Company in the most expeditious manner possible. 2. Iwill not endorse, deposit cash or athemise negotiate any financial instrument made payable to The Company or to thd parties 3. 1 wll not make, modiy oF approve any contracts for the purpose of exending the time for payment of premiums, of to wave, foret or fexonerate any ofthe right or requirements of The Company or bind , through my statements of representation nor will accept any extra Premium for addtional sks, unless approved, inwting, by The Company 4. Iwill not use The Company name, logo and plans in any type of advertising campaign in any medium, including newspapers. magazines, ‘television adi, Internet or othet means, unless such advertsing campaign has been approved, in iting, by The Company 5. _Lwill not sign any document related to The Company on behalf of any person or entity, with or without that persons or entity's consent. il otsign as witness to any person’ signature on any document, unless i's signed in my presence by that petson. 6. 1 ll not enter into any contractual arrangements, or others, forthe solitatin of business ftom of to share commissions wih any third Patties or enter who are not contracted by The Company, 7. will not retain any document provided to me by 2 client or prospective client fora period of time longer than necessary forthe purpose of ie anatysis, oiganzation and review, unless authored in iting by the eient or prospective cent. 8. wil not modify any Company document or fay the age. sex, weight, heakh condtion, use (or not) of tobacco, of any ether fact that ‘makes an individual insurable and that may alec the decision of The Company regarding the Bsuance of a policy and ts ievels of coverage. ©. ill not pay or offer to pay any incentive to 2 person to purchase insurance coverage with The Company ot to purchase the products i oes 10. twill not change or suggest to change an applicant o poiy-owner'saddess for my beneft or that ofthe applicantpolcy-ovner, unless the change & real, and | ill not eonduct unauthorized actives in my cents behaff, 11. wll not represent to any person that my telatonship with The Company & other than that ofan intermediary representing the proposed incured or insured 12. will not misrepresent my relationship wath the Insurance Company to any Customer or anyother party. The mérepresentation o fraudulent andlor ilegal 2c fegatding The Company or #s ploducts which may adversely affect The Company, the patent company of any oft affllats, including but not imited to, msrepresentation as to the terms and provisions of an application, the medical information or the claims, the insurance polcy of contract and any altetation, fabifeation or withholding of any information, whether wiften of oral about an application of applicator prospective insure, andthe wahholding of any information required forthe underwriting process. The improper handing of premiums, commission or claims payments ©. The deseluton of 2 corporate entity thats party to this Agreement 13._I'shall not improperly report or manage the payment of premiums nor the receipt of commission. or othemise pattcipate in any fashion in fraudulent or legal act, ncluing, nthout imation elaing tothe submission of any appicaion, medical infermaton, ot claims infrmatogBest Doctors: NS URANCE {for an insurance polity ftom the Insurance Company, ot patcipate in any money laundering activty whether related to this Agreement or thence [Signature Pages Follow}Agreement Signature Page By executing tis Agreement, Master Agent agrees to comply withthe terms of thi Agreement and tobe compensated in accordance with the tems of ‘this Agreement for a8 dealings with the Insurance Company ot any oft afiiates unless Master Agent enters ino a Separate wien agreement with such affiiate, 2y signing tis Agreement, The Company, as well as the Agent. automatically terminates any other verbal or wrtten agreements) existing bebveen ‘hem as fo the payment of commissions. ‘By Master Agents signature below, helsheft agrees to these tems as of the date written below. Wame of Prospective Agent | Waster Agent TW Agency, Name and Tie of Signatory Date of Execution naa, Passport County/Passport Number: Tne aUaT, te OF BAH EITIT sender Weompany, ‘county of organization and Register Number: Pyaica and Maing Aaa Deseipton cy County: Telephone Wabi Telephone: Fane Ena By his ters signature below, the Master Agent agrees to these terms as of the date witen below, Date: Signature of Master Agent Name of Person Signing on Behalf of Master AgentAgreement Signature Page By General Agents signature below, helshelt agrees tobe bound bythe restctions and obligations of an Agentsetforth inthe Agent Agreement, 2 ‘copy ofwhich nas been provided to Agent, and agiees tothe commésion rules provided below. Name of General Agent By: Date: Name Tite: By Agents signature below, helshe/t agrees to be bound by the restictions and obligations ofan Agent setforth in the Agent Agreement, a copy of ‘which has Been povided to Agent. and agrees tothe commission rules provided belon, Name of Agent By: Date: Name Tite: By i signature below, the Insurance Company agrees to these terms a5 ofthe date witen below. est Doctors Insurance Limited By: Date: Name Tite:‘Appendix A “The commissions” structure for individual and family pokey sales forthe Insurance Company shall be as set forth below as agreed by the parties unless 2 later stuctures putin place and signed by all partes. Date Commission Structure Produ year Commision Renewal Common Maes ERE Premier PRE Gaba Cae Tamas Cae Medea Care “Ravanced Care (Ohi only ‘Favance Care Pls (Chie oni) * Product avalabilty sited to specific mahets Production Requirement: §, in new sales per year ‘This Production Requirement wilbe adjusted annualy in accordance withthe average premium increase as stated by the Insurance Company. Persicteney Requirement: 65% renewal on a veat-t-veat basi ‘Special Ayeem ente [Al bonuses. convention commiments, advances, pre-payment, ot any other similar agent compensation other than Commissions are made avaiable ‘on a yealy basis and shall be revised outside the formal modification requiements of this Agreement. All caleulations made in connection with such ‘compensation ate subject to final determination bythe Insurance Company