Agent Commission Submission
⚠️
Important Reminder
Please submit
Only one form per application
.
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?
Is your E&O (Errors & Omissions) Insurance currently active?
*
Active E&O is required. Commissions may be held without it.
Are you enrolled in the Tevah Platfform?
*
Active Tevah account requiered to get paid
Product Type
Company Name
Product Name
Company Payout Percentage
*
Monthly Premium
*
$
Annuity Amount
*
$
Target Points on Illustration
*
Death Benefit Amount
*
$
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 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
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Submit
