By clicking the "I agree" checkbox below, I state the following:
- I am a duly licensed and appointed (if appointment is required) life insurance agent in the state where the applicant was solicited and in the state where the policy (if one is issued) will be delivered.
- If I am not currently appointed, I understand that I will need to be appointed by Protective Life Insurance Company, before any issued policy can be delivered
- The product and amount of insurance identified are suitable in view of the proposed insured's insurance needs and financial objectives
- The information provided is complete, accurate, and correctly recorded
- All forms required to be delivered at time of solicitation have been delivered, and all other required forms (including privacy notices and/or sales materials, if necessary) have been or will be provided in a timely manner to the applicant
- I have asked the applicant about any existing life insurance or annuities and certify that all replacement sales (if applicable) have been made in accordance with the Company's corporate policy
- I authorize Protective Life Insurance Company to obtain such administrative information as may be necessary to complete any life insurance application resulting from this submission; provided however, that any item of information or question from the proposed policy owner or insured requiring the advice or assistance of a licensed life insurance agent will be referred to me for action before the application can be completed
- I have obtained sufficient information about the client to mitigate risks associated with money laundering, terrorist activity/funding, and to avoid doing business with a sanctioned individual or resident of a sanctioned country
- I will not deliver the policy unless I have completed a review and I am satisfied that the application, policy, and all attached forms, if any, are complete and accurate
- I acknowledge that clicking the "I AGREE" checkbox below constitutes my signature on the form, which has the same effect as if I personally signed the form
- In addition to the authorizations referenced in the preceding paragraphs, clicking the "I AGREE" checkbox below will constitute my legally binding signature on the completed application and on all other required forms.
I hereby agree to the provisions in this attestation and I authorize Protective Life Insurance Company to affix my signature to the application and all other required forms.
Note: A copy of the application and all required forms will be included in the policy packet, if a policy is issued. A copy will be made available to you upon request.
