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State Licensed *
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License Number *
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Contract Name *
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Contact Person First/Last Name *
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Address *
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Address 2
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City *
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State *
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Postal Code *
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Country of Residence/Place of Business *
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Telephone Number *
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Fax Number
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Website
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Type of Producer
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For Tax Reporting Purposes, use the following:
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COMPENSATION SCHEDULE - AGENT
PRODUCER, INDIVIDUAL INSURANCE PRODUCTS Commissions and renewal commissions equal to the percentages shown shall apply to premiums received on Certificates placed in force under this Producer Agreement (Agent) during the effectiveness of this Schedule, excluding applicable taxes, if any. Commissions and renewal commissions, bonuses or other compensation which IMG pays directly to Sub-Producers or their executors, administrators, surviving spouses, or estates. | Commission (%)
Certificate Year 1 | Renewal commissions (%)
Certificate Years 2 plus | Patriot Series | 10 | N/A | Global Series | 15 | 5 | GEO / GEM | 6 (Dental 4%) | 6 (Dental 4%) |
Monthly Commissions are calculated using the following formula: Monthly Gross Premium | - | Applicable Surplus Lines Taxes | X | Commission Percentage | = | Gross Commission |
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Signature *
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Password *
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Confirm Password *
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