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The Special Registration Review Form (SRR Form) is an essential document for individuals seeking to join the Primerica Field Force who have answered "YES" to any of the QUALIFICATION INFORMATION questions in the Independent Business Application (IBA). It requires detailed disclosures about the applicant's legal, financial, and criminal history to ensure compliance with laws governing the financial services industry. If you find yourself in this category, completing the SRR Form accurately and submitting it promptly to your RVP and OSJ for review is crucial for your application process.

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Navigating the pathway to becoming part of the Primerica Field Force demands thorough understanding and meticulous attention to detail, particularly when it comes to legal and regulatory compliance. For those applicants who have faced legal, financial, or employment challenges in the past, the Special Registration Review Form (SRR Form) becomes an essential step in the application process. This form is specifically designed for individuals who answer "YES" to any of the qualification questions posed in the Independent Business Application (IBA), necessitating a deeper dive into the applicant’s background. The SRR Form requires applicants to disclose any criminal, employment, financial, or legal history comprehensively. This process ensures that all disclosures are truthful, complete, and accurate, which is not only a precondition for consideration for joining Primerica's ranks but is also critical for maintaining integrity within the financial services industry. The form encompasses a series of threshold questions aimed at immediately identifying any disqualifying events in an applicant's past. For those that clear this initial hurdle, a detailed account of specific events, supported by additional documentation when necessary, is required. The information gathered through this form undergoes a Special Registration Review process, the outcome of which could either be the acceptance of the applicant under certain conditions or the denial of their application. It is crucial for potential applicants to understand that until officially accepted into the Primerica Field Force, and expressly authorized in writing, they are not permitted to engage in Primerica business activities. This underscores the importance of the SRR Form in ensuring that only individuals who meet the stringent standards of trustworthiness, good character, and regulatory compliance are allowed to participate in offering financial services under Primerica.

Question	Answer
Form Name	Srr Form
Form Length	2 pages
Fillable?	Yes
Fillable fields	41
Avg. time to fill out	8 min 46 sec
Other names	primerica iba, primerica srr form, primerica srr, primerica transfer forms

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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 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 and OSJ for review.

APPLICANT’S NOTICE

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, securities or loan origination licensing forms), you must fully disclose that history, when requested, to be considered 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 the THRESHOLD questions below. If the answer is “yes” to any of the five THRESHOLD questions below, you are NOT eligible to join the Primerica Field Force and you will not need to review or complete the remainder of this form. 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. If your answer is “no” to all of the five THRESHOLD questions below, you should review and complete the remainder of this Form. When doing so, be sure to dis- close 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 first-offender sentencing or conditional discharges), even if later expunged; any conviction or entry of a sentence, whether probation, fine, community service or otherwise.

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 in to 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. If you choose to pay your IBA fee and go forward in the licensing process, 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)

THRESHOLD QUESTIONS

Please read each of the five questions below and answer “yes” or “no.” When we say “you” in the questions below, we mean you personally and also any organization that you owned or had a controlling ownership interest in or controlled as a principal manager. If the answer is “yes” to any of the questions, you are NOT eligible to join the Primerica Field Force.

1.	Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a FELONY crime?	YES	NO
2.	Have you, WITHIN THE LAST 10 YEARS, pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a	YES	NO
	MISDEMEANOR crime involving: (a) a financial industry law, rule or regulation; (b) lying/dishonesty, cheating or
	fraud, money laundering or breach of trust; or (c) burglary, or theft (in any form) of funds or securities or financial
	instruments?
3.	Has any state regulator found that you violated any law or regulation that prohibits fraudulent, manipulative or deceptive	YES	NO
	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,
	money laundering or drug dealing or distribution?
4.	Are you NOW affiliated as an employee or independent contractor with a regulator or other entity providing underwriting or	YES	NO
	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.
5.	Is there NOW pending against you any criminal court action? Include any pre-trial intervention program, deferred prosecution	YES	NO
	program, conditional discharge program, court-ordered community service requirements, or any probation requirements.

If the answer is “yes” to any of these five questions, you do not need to review or complete the rest of this Form.

5.10

If you answered “no” to all of the THRESHOLD QUESTIONS on the front pages, please continue completing this Form by reading each question below and answering “yes” or “no.” If the answer is “yes” to any question, you must provide complete details about your answer on a separate page.

6. Have you EVER been charged with, but not convicted of, a FELONY crime? Check “yes” here even if the charges were		YES	NO
	later dismissed, dropped, reduced, or expunged.
7. Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a MISDEMEANOR crime		YES	NO
	involving sexual misconduct or indecency?
8. Have you, WITHIN THE LAST 10 YEARS, been CHARGED WITH, or pled guilty or nolo contendere (“no contest”) to, or		YES	NO
	been found guilty of, a MISDEMEANOR crime involving (1) theft (in any form) of property other than funds or securities
	or financial instruments; (2) violence or threats of violence; or (3) drug dealing or distribution?
9. Have you EVER been the subject of any civil court or regulatory or administrative agency inquiry, action, litigation, arbitration		YES	NO
	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 drug dealing or distribution, 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,	YES	NO
	profession or government contract, or been denied a trade or professional license, or had a trade or professional license
	revoked, suspended, cancelled, non-renewed or restricted?
11.	Has a bonding company ever denied, paid out on or revoked a bond on you?	YES	NO
12.	Are you NOW, in any way, involved in or licensed for the marketing or promotion of financial services NOT involving	YES	NO
	securities or investments? You may be required to sign an alternative agreement based on the license conflict

13.	Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a crime NOT specified in	YES	NO
	questions 1, 2, 6, 7 & 8 of this SRR Form?
14.	Have you ever voluntarily resigned, been discharged or permitted to resign from any contract, position or employment,	YES	NO
	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, money laundering or drug dealing or distribution?
15.	Have you, WITHIN THE LAST 10 YEARS, made a compromise with creditors or been the subject of a bankruptcy petition, or	YES	NO
	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

On A SEPARATE PIECE OF PAPER for each “yes” answer, please describe actions leading to the event, beginning and ending dates, and other details about your answers above. Also attach any supporting documents you have verifying the information provided. For criminal court (#s 6, 7, 8, 13) and agency mat- ters (#s 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 11, 15, 16), please describe the event fully, its resolution or current status, and whether (and in what amount) you currently have defaulted debts or liens outstanding.

FIELD APPROVAL

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 the references the applicant has made known to me through the IBA have been or will be checked and that a thorough background interview has otherwise been performed. After carefully reviewing all information available to me in this matter, I believe that the applicant is trust- worthy 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

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