REINSTATEMENT OF AGENT’S CONTRACT

Date: ________________

I, under named hereby request for the above and confirmed that all parties concerned have been duly
consented
Agent’s Info
Agent Code : Unit No:
Name
Agency Name : Region :
Termination
Rank Prior to Date :
Agent AUM
Termination : Terminate
Due To :
Email
Mobile No
Address

Signature Date :

We, the undersigned hereby unconditionally consented for the above request.

_____________________________________ _________________________________________
Agent’s Name : Endorsed by UM/DM
Agent Code : Name :
Agency Name :
For Agency Distribution Use :

Endorsed by DOA/SDOA :

Date :

Remarks :

Important Notes :
i) Incomplete form will be rejected.
ii) Maximum reinstatement is twice per life time
iii) In order to restore all the policies servicing rights before termination date to the original agent, the
reinstatement request should be submitted a month from the termination date. Any request thereafter,
all the policies should be auto roll up to the leader for servicing and commission (as per indicated in the
handbook).