Form La02298 - Partnering With Lincoln Financial (Page 4 of 4) in pdf

FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION

DISCLOSURE OF USE OF CONSUMER REPORTS

As part of the appointing and/or contracting process, The Lincoln National Life Insurance Company and its affiliates (hereinafter,

Lincoln), request consumer reports on prospective producers. From time to time after appointing and/or contracting, Lincoln

reserves the right to request consumer reports on its producers in connection with their contracts or new appointments.

Occasionally, Lincoln requests investigative consumer reports, which include personal interviews with sources such as your

neighbors, friends, associates and/or former employers. Consumer reports and investigatory consumer reports may include

information about any or all of the following: your character, general reputation, personal characteristics, mode of living, education,

past employment, credit report, professional credentials or your driving and criminal record. If we request an investigative report,

we are required by the Fair Credit Reporting Act to notify you within three days after the report is requested, and if you make a

written request, we are obligated to disclose to you within five days the nature and scope of the investigation requested.

Consumer reports and investigative consumer reports, as well as other information in your file, may be shared among Lincoln

Financial Group and its affiliates and parties recruiting and recommending your appointment unless you direct otherwise.

CALIFORNIA RESIDENTS

Summary of the provisions of section 1786.22 of the California Investigative Consumer Reporting Agency Act

a. An investigative consumer reporting agency shall supply files and information required under Section 1786.10 during normal

business hours and on reasonable notice.

b. Files maintained on a consumer shall be made available for the consumer’s visual inspection, as follows:

1. In person, if he appears in person and furnishes proper identification. A copy of his file shall also be available to the

consumer for a fee not to exceed the actual costs of duplication services provided.

2. By certified mail, if he makes a written request, with proper identification, for copies to be sent to a specified addressee.

Investigative consumer reporting agencies complying with requests for certified mailings under this section shall not

be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative

consumer reporting agencies.

3. A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be

provided by telephone, if the consumer has made a written request, with proper identification for telephone disclosure,

and the toll charge, if any, for the telephone call is prepaid by or charged directly to the consumer.

c. The term “proper identification” as used in subdivision (b) shall mean that information generally deemed sufficient to identify

a person. Such information includes documents such as a valid driver’s license, social security account number, military

identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with information described

above, may an investigative consumer reporting agency require additional information concerning the consumer’s employment

and personal or family history in order to verify his identity.

d. The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information

furnished to him pursuant to Section 1786.10.

e. The investigative consumer reporting agency shall provide a written explanation of any coded information contained in files

maintained on a consumer. This written explanation shall be distributed whenever a file is provided to a consumer for visual

inspection as required under Section 1786.22.

f. The consumer shall be permitted to be accompanied by one other person of his choosing, who shall furnish reasonable

identification. An investigative consumer reporting agency may require the consumer to furnish a written statement granting

permission to the consumer reporting agency to discuss the consumer’s file in such person’s presence.

AUTHORIZATION

I authorize The Lincoln National Life Insurance Company and its affiliates to request and obtain one or more consumer reports

and/or investigative consumer reports about me for appointing and/or contracting purposes, and to share such information

within Lincoln Financial Group and its affiliates as well as with parties recruiting and recommending my appointment unless I

direct you otherwise.

Date: ______________________________

Name (Print): __________________________________________________

Name (Sign): __________________________________________________

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.

Page 1 of 1

LA02298

04/07

Form La02298 - Partnering With Lincoln Financial Page 4

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