CORE BENEFITS GROUP ACKNOWLEDGMENT AGREEMENT

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NPN#: 90987654

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000000-0000

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Contract Core Benefits Group Inc. for additional information: 901-221-8834

Core Benefits Group Inc. Commission and Advance Commission Acknowledgment and Agreement:

Earned Commission;

1. Commission that is not paid direct by a Carrier will be paid by Core Benefit Group Inc. If and when commission is owed because of a sale or secured sale of an insurance product or any other reason, I authorize Core affiliated companies to pay Core Benefits Group Inc. for the distribution of such commission.

Advance Commission;

1. Commission may be paid on an advance basis for the sale of a qualifying insurance product.

2. Unearned commission advanced on any product under this Agreement shall constitute an indebtedness of the Producer and shall be treated as income at the date of disbursement.

3. All unearned commission payments made under this Agreement shall be made by Core Benefits Group Inc. and forwarded to the Producer

4. The total amount of unearned commission payments shall be considered the Producer's indebtedness. Core Benefits Group Inc. reserves the right to determine a maximum total indebtedness.

5. In the event of termination of this agreement, producer becomes inactive or upon demand, all unearned commission in excess of commission earned shall be due and payable to Core Benefits Group Inc. immediately. To assure that the indebtedness will be repaid, Producer hereby grants to Core Benefits Group Inc. a first priority security interest in and right to offset against the following: any commissions and bonuses payable to Producer by Core Benefits Group Inc. or any of its affiliates and any credits and value from property held in Producer's name with Core Benefits Group Inc.

6. Core Benefits Group Inc. may, at its sole discretion, modify the terms of this Agreement at any time. Such modification shall take effect upon Core Benefits Group Inc. mailing notice of modification to the last known address of the Producer. Any business signed prior to the modification shall be processed in a manner previous to such modification.

7. This Agreement shall survive the termination of all contractual relationships between the undersigned and Core Benefits Group Inc. It is further agreed that in the event it becomes necessary to enforce payment of this Agreement through legal action. Producer agrees to pay the reasonable attorney fees and court costs incurred by Core Benefits Group Inc. All amounts due hereunder shall be payable at Core Benefits Group Inc.'s office in Hampstead, New Hampshire.

8. This Agreement shall have no force or effect until accepted by Core Benefits Group Inc.

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CORE BENEFITS GROUP COMMISSION AND ADVANCE COMMISSION ACKNOWLEDGMENT AND AGREEMENT

Core Benefits Group Inc. Commission and Advance Commission Acknowledgment and Agreement: