Disclosure for London Life - BridgeForce Financial



Advisor information for clients concerning

AGENT NAME

About Me

I am licensed for life insurance, health insurance, income protection products, mutual funds and investment funds in the province(s) of Ontario, etc. My license numbers are: personal license ________________ , corporate license ___________ and mutual funds license ________________.

I have the following designations CFP, CLU, CH.F.C. and a B.A. from the University of Somewhere.

Companies’ products made available

I have access to the following companies’ products:

• AIG Life

• Assumption

• AXA Insurance

• Canada Life

• CI Investments

• Empire Financial Group

• Equitable Life

• Industrial Alliance

• LaCapitale

• Manulife Financial

• RBC Insurance

• Standard Life

• Sun Life

• Transamerica Life

• UL-Mutual

• Unity Life

• Wawanesa Life

Mutual Funds

My mutual funds sales are through ____________________________., a mutual fund dealer and member of the Mutual fund Dealer Association (MFDA). I receive commission from the sale of mutual funds through this company with a portion of all commissions retained by _________________________ as compensation for their services.

Compensation

My suppliers pay a first year and renewal commission for my sales with their company and these commissions are based on their current standard broker commission schedules. In addition, these base commissions are supplemented by a first year override commission paid to me by _______________________, a MGA organization. The MGA also provides me with marketing support and administration services. In some cases, our suppliers and /or our MGA offer us travel allowances for conventions and /or contest rewards based on my sales productivity.

Nature of relationship

No insurer holds an ownership interest in my business, nor do I hold a significant interest in any insurance company.

Conflict of interest

I take the potential of a conflict of interest seriously. I will notify you if there is a conflict of interest of which I become aware in regards to my services. My services will take into consideration your financial needs.

This statement has been prepared by (Agent Name) and (Agent Name) alone is responsible for its accuracy.

Acknowledgment (1)

I, ____________________________ have been informed of, and understand the implications of, this disclosure including any conflict of interest or potential conflict of interest associated with _________________________________ in relation to any recommendations made.

I agree to continue discussions with you and understand that I may ask for further information regarding this disclosure.

Client signature ________________________________ Date ________________

Agent signature ________________________________ Date _________

Acknowledgment (2)

I, _______________________________ have received and been informed of the privacy policy

(Client Name)

of _______________________________.

(Agent Name)

Client signature _______________________________ Date ______________

Agent signature _______________________________ Date ______________

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