Mutual Agreement for Termination of Agency Agreement
Mutual Agreement made on the (date), between (Name of Principal) of (street address,
city, state, zip code), and (Name of Agent) of (street address, city, state, zip code),
The undersigned hereby mutually agree that the Agency Agreement, a copy of which is
attached hereto as Exhibit A, together with any and all modifications, amendments and
riders, written or oral, be and is terminated as of (date).