Article Structure
The Special Registration Review Form (SRR Form) is an essential document for individuals applying to join the Primerica Field Force. It becomes particularly important for those who answered "YES" to specific qualification questions in the Independent Business Application (IBA). Each applicant must submit a separate SRR Form for every event that prompted such a response. This form requires applicants to disclose any relevant criminal, employment, financial, or legal history meticulously. It is crucial to complete the SRR Form truthfully, as any discrepancies could impact the eligibility for membership within Primerica. The initial step involves answering five threshold questions; a "yes" answer disqualifies an applicant from joining without the need to continue with the form. If an applicant responds "no" to all threshold questions, they must further address additional queries about their background, including any past criminal charges or regulatory inquiries. The completed form should be submitted to the applicant's Regional Vice President (RVP) and Office of Supervisory Jurisdiction (OSJ) promptly for review, keeping in mind that it is not authorized to conduct Primerica business until receiving written acceptance from Primerica’s Licensing Department. The SRR Form underscores the importance of compliance with laws governing the financial services industry, ensuring that all disclosures are accurate and complete.
Srr Example
Special Registration Review Form (SRR Form)
Applicant’s Full Name (Print) |
Applicant’s Social Security No. |
Please complete this SRR Form if you answered “YES” to one of the QUALIFICATION INFORMATION questions in the Independent Business Application (IBA). You should complete a separate SRR Form for each “event” leading you to answer “YES”. Feel free to print or photocopy this SRR Form and/or attach more sheets of paper as needed to provide the requested information. Submit the completed SRR Form as soon as possible to your RVP for review.
APPLICANT’S NOTICE
_________________________________________________________________________________________________________________________ J
Laws in the financial services industry affect who may and may not be a member of the Primerica Field Force. Because of these laws, your IBA and this SRR Form ask you certain questions about your legal background. If you have criminal, employment, financial or legal history that is requested by the IBA, this SRR Form or other applicable forms (including insurance or securities or licensing forms), you must fully disclose that history, when requested, to be consid ered for and remain in the Primerica Field Force. You should take care to ensure that your disclosures are truthful, complete and accurate.
You should start this Form by reviewing and answering the background questions below. In some instances, when the answer is “yes," attempting to engage in financial services may constitute illegal activity punishable by incarceration, fines or regulatory sanctions. When completing this form, be sure to disclose fully any requested information, particularly information relating to any felony or other crime: any charges, even if they were later dropped, dismissed or reduced; any plea of guilty or no contest/nolo contendere or any entry of a deferred adjudication (sometimes called
Primerica considers this information under a Special Registration Review process. The end result of that process may be the denial of your application to join the Primerica Field Force or your acceptance only under conditions that Primerica deems appropriate. Until Primerica’s Licensing Department notifies you in writing that you have been accepted into the Primerica Field Force, you are not authorized to conduct any Primerica business. Also, before you can solicit for any product that requires a license or company authorization, you may not engage in that line of business until you are first notified in writing that you are authorized. Ask your RVP for further guidance. Until you are notified, you may attend Primerica education classes and participate in field meetings and training.
By signing below, you acknowledge your understanding and agreement with the matters noted above. You also certify that the disclosures you make in your IBA and on this Form are truthful, complete and accurate.
Date |
Applicant (Signature) |
BACKGROUND QUESTIONS
Please read each of the questions below and answer "yes” or “no.” When we say “you” in the questions below, we mean you personally and also any organi zation that you owned or had a controlling ownership interest in or controlled as a principal manager.
1. |
Have you EVER pled guilty or nolo contendere ("no contest") to, or been found guilty of, a FELONY crime? |
YES |
C NO |
2. |
Have you EVER been charged with, but not convicted of, a FELONY crime? Check “yes” here even if the charges were |
YES |
NO |
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later dismissed, dropped, reduced, or expunged. |
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3. |
Have you, EVER, pled guilty or nolo contendere ("no contest") to, or been found guilty of, a |
YES |
NO |
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MISDEMEANOR crime involving: (a) a financial industry law, rule or regulation; (b) lying/dishonesty, cheating or |
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fraud, money laundering or breach of trust; or (c) burglary, or theft (in any form) of funds or securities or financial |
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instruments? |
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4. |
Have you, EVER, been CHARGED WITH, or pled guilty or nolo contendere ("no contest”) to, or been found guilty |
YES |
NO |
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of, a MISDEMEANOR crime involving (a) theft (in any form) ofproperty other than funds or securities or financial |
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instruments or (b) violence or threats of violence? |
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5. |
Have you EVER pled guilty or nolo contendere ("no contest) to, or been found guilty of, a MISDEMEANOR crime |
YES |
NO |
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involving sexual misconduct or indecency? |
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6. |
Have you EVER pled guilty or nolo contendere ("no contest") to, or been found guilty of, a crime NOT specified in |
YES |
NO |
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questions 1, 2, 3, 4 or 5 above? |
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7. |
Is there NOW pending against you any criminal court action? Include any |
YES |
NO |
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program, conditional discharge program, |
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3.13
8.Has any state regulator found that you violated any law or regulation that prohibits fraudulent, manipulative or deceptive conduct, or are you CURRENTLY expelled, suspended, barred or prevented by the order, judgment or decree of a civil court or a regulatory or administrative agency from engaging in financial or professional services, or are you under investigation, sentencing or order for alleged misconduct regarding financial services, lying/dishonesty, cheating or fraud, breach
of trust, theft in any form, burglary, sexual misconduct or indecency, violence or threats of violence or money laundering?
9.Have you EVER been the subject of any civil court or regulatory or administrative agency inquiry, action, litigation, arbitration or order, judgment or decree involving allegations of misconduct regarding financial services, lying/dishonesty, cheating or fraud, breach of trust, theft in any form, burglary, sexual misconduct or indecency, violence or threats of violence, money laundering or are you NOW the subject of an unresolved customer complaint or regulatory proceeding?
10.Have you EVER been expelled, suspended, barred or enjoined (prevented by court order) from engaging in a trade, profession or government contract, or been denied a trade or professional license, or had a trade or professional license revoked, suspended, cancelled,
11.Are you NOW affiliated as an employee or independent contractor with a regulator or other entity providing underwriting or investigative services to Primerica, or are you, in any way, involved in or licensed for marketing or promoting securities or investments, raising investment funds, or planning, handling or advising on the investments of others?
12.Are you NOW, in any way, involved in or licensed for the marketing or promotion of financial services NOT involving securities or investments? You may be reauired to siqn an alternative agreement based on the license conflict
13.Have you ever voluntarily resigned, been discharged or permitted to resign from any contract, position or employment, including a military position, after allegations were made that you engaged in misconduct regarding financial services, lying/ dishonesty, cheating or fraud, breach of trust, theft in any form, burglary, sexual misconduct or indecency, violence or threats of violence or money laundering?
14.Has a bonding company ever denied, paid out on or revoked a bond on you?
15.Have you, WITHIN THE LAST 10 YEARS, made a compromise with creditors or been the subject of a bankruptcy petition, or had unsatisfied judgments or liens pending against you?
16.Are you now, as an agent, indebted to any insurance company, general agent, manager or broker?
□ YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
□YES □ NO
On A SEPARATE PIECE OF PAPER for each "yes” answer above please describe actions leading to the event, including beginning and ending dates. Also attach any supporting documents you have verifying the information provided. For criminal court (#s 1, 2, 3, 4, 5, 6, 7) and agency matters (#s 8, 9 ,10), list the name of the crime or allegation and the Code section under which you were charged, the resolution of the charge, and the details of any sentencing, discipline or orders relating to the matter. You may wish to contact the lawyer who handled your case for details and fax a copy of this Form to the attorney to help you. For financial information (#s 14,15,16), please describe the event fully, its resolution or current status, and whether (and in what amount) you currently have judgements, liens or debts outstanding.
[FIELD APPROVAL
<_________________________________________________________________________________________________________ ______________________ z
RVP Certification. I have received and reviewed this completed form and any applicable documents. I have met or talked with this applicant and find the appli
cant to be credible. I have ensured that a thorough background interview has been performed. After carefully reviewing all information available to me in this matter, I believe that the applicant is trustworthy and of good character, will protect/promote the goodwill/reputation of Primerica and the Field Force, and is otherwise qualified to join the Primerica Field Force. I will immediately report to Primerica’s SRR Unit or Office of the General Counsel information I receive that changes my belief. I will supervise the applicant carefully in light of his/her background and any undertakings herein. I recommend that the applicant be permitted to join the Primerica Field Force.
Date |
RVP Signature |
RVP Solution Number |
OSJ Certification. After carefully reviewing the information available to me in this matter, I believe that the applicant is trustworthy, of good character, will protect/ promote the goodwill/reputation of Primerica and the Field Force, and is otherwise qualified to join the Primerica Field Force. I believe, and will take steps to ensure, that the RVP will supervise the applicant carefully in light of the applicant’s background and any undertakings herein. I support the RVP’s recommendation.
Date |
OSJ Signature |
OSJ Solution Number |
© 2013 Primerica / 45950 / 3.13 /
Form Characteristics
| Fact Name | Fact Description | Governing Law(s) |
|---|---|---|
| Purpose | The SRR Form is used to disclose information related to the applicant's legal background, especially when the applicant answers "YES" to specific qualifications. | None specified |
| Threshold Questions | Applicants must answer five threshold questions. A "YES" response disqualifies them from joining the Primerica Field Force. | State regulations may apply |
| Disclosure Requirement | Applicants must fully disclose any criminal, employment, or legal history as requested by the form. | State regulations regarding disclosures |
| Application Process | Submitting the form to RVP and OSJ is a required step in the application process for joining the Primerica Field Force. | Applicable state licensing laws |
| Interview Requirement | The applicant must meet with the RVP, who will assess their credibility and background before recommending them for acceptance. | No specific governing laws |
| False Disclosures | Providing false information on the SRR Form can lead to disqualification and potential legal consequences. | Fraud laws, state regulations |
| Condition of Acceptance | Acceptance into the Primerica Field Force may come with conditions based on the applicant's background. | State licensing requirements |
Guidelines on Utilizing Srr
Completing the Special Registration Review (SRR) Form is a crucial step for those applying to join the Primerica Field Force. The form requires specific information and disclosures, particularly regarding your legal and financial background. Accurate and honest responses will ensure your application is properly assessed. Follow the steps below to fill out the form correctly.
- Begin by printing your full name in the designated field.
- Enter your Social Security Number in the appropriate section.
- Determine if you answered “YES” to any of the qualification questions in the Independent Business Application (IBA). If “YES,” do not proceed with the form.
- If you answered “NO” to all THRESHOLD questions, continue to the next section. Review each question carefully.
- Answer each THRESHOLD question with “YES” or “NO.” Be truthful and thorough.
- If the answer is “YES” to any THRESHOLD question, stop filling out the form. You are not eligible.
- If all THRESHOLD questions are marked “NO,” continue to the remaining questions on the form.
- For any “YES” responses in the subsequent questions, provide detailed explanations on a separate page.
- Attach any relevant supporting documents that support your answers.
- Review your completed form and all attachments for accuracy.
- Sign and date the form, certifying that all disclosures are truthful, complete, and accurate.
- Submit the completed SRR Form to your RVP and OSJ for their review.
What You Should Know About This Form
What is the purpose of the SRR Form?
The Special Registration Review Form (SRR Form) is used for applicants who have answered "YES" to certain questions in the Independent Business Application (IBA). It helps evaluate a candidate's qualifications and legal background to determine eligibility for membership in the Primerica Field Force.
Who needs to complete the SRR Form?
If you answered "YES" to any of the qualification information questions in your IBA, then you must complete a separate SRR Form for each relevant event. This ensures that all necessary details regarding your legal history are disclosed.
What kind of information is required on the SRR Form?
The SRR Form requires details about any criminal, employment, financial, or legal history impacting your application. This includes felony or misdemeanor convictions, charges even if they were dropped, and any relevant civil or regulatory inquiries.
What happens if I answer "YES" to any of the THRESHOLD questions?
If you answer "YES" to any of the five THRESHOLD questions, you are not eligible to join the Primerica Field Force. No further review of the form is needed, and you should refrain from engaging in financial services.
What should I do if I answered "NO" to all the THRESHOLD questions?
If all your answers to the THRESHOLD questions are "NO," you should continue to complete the rest of the form. Ensure you disclose any additional required information thoroughly and accurately.
What is the timeline for submitting the SRR Form?
You should submit the completed SRR Form as soon as possible to your Regional Vice President (RVP) and Office of Supervisory Jurisdiction (OSJ) for review. Quick submission helps facilitate your application process.
What are the consequences of providing inaccurate information?
Providing false or misleading information on the SRR Form can lead to the denial of your application or future disciplinary actions. It is crucial to ensure all details are truthful, complete, and accurate to maintain your eligibility for the Primerica Field Force.
Common mistakes
Filling out the Special Registration Review Form (SRR Form) can be a daunting task, especially when applicants want to ensure their eligibility to join the Primerica Field Force. However, several common mistakes can jeopardize this process. Learning about these pitfalls can make the entire experience smoother and more efficient.
One frequent mistake is failing to adequately read the instructions. The SRR Form is specific about certain requirements, such as completing a separate form for each qualifying event. When applicants overlook this detail, they might submit an incomplete application, which could lead to delays or denials of their request.
Another common error involves providing insufficient or unclear responses. Each question, especially the threshold questions, requires honest and complete answers. If someone marks "no" but has a relevant history, this inconsistency can raise red flags. The forms ask for details on criminal and legal history, and anyone tempted to omit or minimize this information should think twice. Transparency is crucial in this process.
Additionally, applicants sometimes neglect to include necessary supporting documents. The form specifically requests details and documentation related to certain answers, particularly those involving criminal charges or financial issues. When omitted, these documents can hinder the review process, leaving the reviewing parties with incomplete information and forcing them to reach out for clarification, which further delays the application.
A related mistake is assuming that previous expungements or dismissals automatically negate the need to disclose prior issues. The form explicitly states that individuals must disclose any charges, regardless of their current status. Ignoring this requirement can lead to significant consequences, potentially resulting in disqualification from the Primerica Field Force.
Finally, not seeking guidance when in doubt can be a significant misstep. The SRR Form encourages applicants to contact their Regional Vice President (RVP) for clarification. Engaging in a dialogue can help clarify uncertainties, ensuring that applicants submit their forms accurately and maximize their chances of approval.
Documents used along the form
The Special Registration Review Form (SRR Form) is a critical document in the application process for joining the Primerica Field Force. However, several other forms and documents often accompany it to ensure a comprehensive review of the applicant's qualifications and background. Understanding each of these documents can help applicants navigate the process effectively.
- Independent Business Application (IBA): This application is the initial step prospective members must complete. It gathers essential information about the individual, including their personal history and motivations for joining Primerica.
- Background Check Authorization Form: This form allows Primerica to conduct a thorough background check on the applicant. It typically requires the applicant’s consent for verification of their criminal history, credit history, and other relevant records.
- Disclosure Statement: This document is where applicants disclose any legal issues such as criminal charges or bankruptcies. Transparency here is crucial, as any undisclosed information can severely affect their application.
- Financial Disclosure Form: This form requires individuals to provide detailed information about their financial status, including income, debts, and any ongoing litigation. This information helps assess their overall financial health.
- Applicant Reference Form: In this document, applicants typically provide references who can vouch for their character and suitability. These references might also undergo separate vetting processes by Primerica.
- Code of Conduct Acknowledgment: This form is a commitment from the applicant to uphold Primerica's standards of conduct and business ethics. By signing this, they acknowledge understanding the expectations tied to their membership.
In conclusion, the SRR Form works in concert with these additional documents to facilitate a thorough evaluation of potential members. By familiarizing themselves with these forms, applicants can better prepare for the review process and increase their chances of a successful outcome.
Similar forms
The Special Registration Review Form (SRR Form) shares similarities with various other documents that serve to gather and assess background information in different contexts. Here are six such documents:
- Background Check Authorization Form: Like the SRR Form, this document collects personal information for a background check. Both require applicants to disclose criminal histories, allowing organizations to evaluate eligibility or risk factors.
- Employment Application: An employment application often asks detailed questions about an applicant’s work history and background. Similarly, the SRR Form includes specific questions regarding legal and financial events that influence eligibility for a role.
- Disclosure Statement for Financial Advisors: This statement requires financial advisors to disclose any legal or disciplinary history to ensure they are fit to practice. The SRR Form also mandates full disclosure of relevant legal history for potential members of the Primerica Field Force.
- Insurance Licensing Application: When applying for insurance licenses, applicants must provide information about any past legal issues. This is akin to the questions posed in the SRR Form, aimed at determining the applicant's suitability for a financial service role.
- Securities Registration Form: Individuals seeking to register for securities must disclose any criminal convictions or regulatory actions. This process parallels the SRR Form’s requirement to disclose similar information when pursuing a role with Primerica.
- Loan Application: Loan applications often request credit history and any financial difficulties. Much like the SRR Form, applicants must be candid about their financial background to be eligible for consideration.
Dos and Don'ts
When filling out the Special Registration Review (SRR) Form, it is important to approach the task with care and attention to detail. Below is a list of things you should and should not do while completing this form.
- Do ensure that all required sections of the form are completed accurately.
- Do read each question carefully before responding.
- Do disclose any relevant criminal or legal history, as required.
- Do provide truthful and complete information to avoid potential issues.
- Do review your responses for clarity and correctness before submission.
- Do not leave any questions unanswered unless indicated otherwise.
- Do not make false statements or omit information to appear more favorable.
- Do not rush through the form; take your time to reflect on your answers.
- Do not forget to sign and date the form after you have completed it.
- Do not delay submission; send the completed form as soon as possible to the appropriate office.
Misconceptions
When individuals consider the Special Registration Review (SRR) form, several misconceptions arise. It is important to address these misunderstandings to ensure that applicants navigate the process with clarity. Below is a list of common misconceptions about the SRR form and explanations for each.
- The SRR form is optional. In reality, if you answer "YES" to any qualification questions in the Independent Business Application (IBA), completing the SRR form is mandatory.
- Filling out the SRR form guarantees acceptance into the Primerica Field Force. Completing the form does not ensure approval. The information provided is assessed, and acceptance may be denied based on the review.
- You can omit minor legal issues from the form. Every part of your legal, employment, and financial history must be disclosed, even if the issues are minor or have been resolved.
- Providing truthful information may lead to automatic disqualification. While honesty is crucial, the evaluation is based on context. Some applicants may still be accepted despite past issues.
- The SRR form is irrelevant for those without a criminal record. Individuals without a criminal history still need to fill out the form, as it covers various legal and professional qualifications.
- Once submitted, the SRR form cannot be changed. If you need to amend details after submission, you are encouraged to do so by contacting your RVP.
- The review process is immediate. The assessment of the SRR form takes time. You must wait for written confirmation from Primerica’s Licensing Department before proceeding with any Primerica business.
Understanding these misconceptions can help individuals approach the SRR form with the appropriate mindset and preparedness. For further clarification, reaching out to your RVP can provide additional guidance and support.
Key takeaways
Here are some key takeaways about filling out and using the Special Registration Review (SRR) Form:
- The SRR Form must be completed if you have answered “YES” to any of the qualification questions in your Independent Business Application (IBA).
- Complete a separate SRR Form for every event that leads to a “YES” answer. This ensures clarity and thoroughness.
- If you have a history of criminal, financial, or legal issues, it’s essential to fully disclose that information when filling out the form.
- Review the THRESHOLD questions first. If you answer “YES” to any of them, you cannot proceed with the application.
- Disclosures must be truthful, complete, and accurate. Inaccurate or incomplete information can lead to denied applications.
- Only submit the form once you have filled it out completely. The goal is to provide all required details upfront.
- Do not engage in any Primerica business until you receive written confirmation of acceptance from Primerica’s Licensing Department.
- Seek advice from your Regional Vice President (RVP) if you have questions during the process. They can offer guidance and support.
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