New Hire Strategy
New Hire Frequency
Start Date
Assigned Account Manager
Method
Case Name
Split Agreement
Split - Carrier #
1
2
3
4
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Carrier 1
ER Paid %
EE Paid %
Ancillary %
Total % must add to 100
Please, make sure this adds to 100
Carrier 2
ER Paid
EE Paid
Ancillary
SUM Carrier 2
Please, make sure this adds to 100
Carrier 3
ER Paid
EE Paid
Ancillary
SUM Carrier 3
Please, make sure this adds to 100
Carrier 4
ER Paid
EE Paid
Ancillary
SUM Carrier 4
Please, make sure this adds to 100
Commissions Distribution
Number of parties splitting commission
1
2
3
4
5
6
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Title 1
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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Name
ER Paid
EE Paid
Ancillary
Title 2
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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Name
ER Paid
EE Paid
Ancillary
Title 3
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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Name
ER Paid
EE Paid
Ancillary
Title 4
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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Name
ER Paid
EE Paid
Ancillary
Title 5
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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List is empty.
Name
ER Paid
EE Paid
Ancillary
Title 6
Producer
Service Enroller
Compliance Enroller
Broker
Administration
Business Development
Coordinator
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Name
ER Paid
EE Paid
Ancillary
SUM ER Paid
Please, make sure this adds to 100
SUM EE Paid
Please, make sure this adds to 100
SUM Ancillary
Please, make sure this adds to 100
Fees
Application fees
Per Diem
Daily rate
Daily rate - Paid by
Expenses
Expenses - Paid by
Bonus - Paid by
Bonus
Is the broker contracted with Coordination Group?
Yes
No
Technology Build Cost
$
Technology Build Waved?
Yes
No
Button
Email