Agent Commission Request Form
⚠️
Important Reminder
⚠️ Commission Eligibility Reminder
1.
Being Licensed & Contracted on State of Application
2.
Tevah Platform
must have been
active
3.
E&O Insurance must have been active on the date the application was submitted to the insurance carrier & at the time policy is paid.
4.
Persistency over 70% - 12 Months Rolling.
Please submit
Only one form per application
.
How to Check Commissiosn in Tevah:
Check Commissions Steps
Do not submit a new ticket if one has already been submitted, as duplicate requests may delay processing.
For follow-ups, please email
[email protected]
and include the ticket or policy number along with any updates or notes.
Submit this form
only after the policy is issued and commissions are released to GFI
.
Agent's First Name
*
Agent's Last Name
*
Agent's Email
*
GFI Agent Code
*
Reason for This Submission: (Please select one)
*
Policy Number
*
Client Full Name in Policy
*
Date the policy was placed in Force/Activated?
Product Type
Company Name
Product Name
Company Payout Percentage
*
Monthly Premium
$
Annuity Amount
$
Target Points on Illustration
*
Death Benefit Amount
$
Writing Agent Direct EMD
Writing Agent Level
Writing Agent Name
Writing Agent Email
Writing Agent Code
Writing Agent Rate
Is there a Split Agent to this Commission?
*
Yes
No
Split Agent Direct EMD
Split Agent Level
Split Agent Name
Split Agent Email
Split Agent Code
Split Agent Rate
Writing Agent Split Percentage
Split Agent Split Percentage
Writing Agent Commission Amount
*
$
Split Agent Commission Amount
*
$
📝 Notes for the Commissions Team
Please Add any pictures, PDFs or Files that may help to process this request faster
Please Add any pictures, PDFs or Files that may help to process this request faster
Submit
