Get Agent Of Record Form Fillable

Filling out the Agent Of Record Form Fillable is a straightforward process that allows you to designate a new insurance representative for your policies. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out your form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Enter the date in the format MM/DD/YYYY indicating when the form is being filled out.
3. In the 'New Agency' section, provide the name of the insurance agency you wish to designate.
4. Enter the phone number including area code in the designated phone field.
5. If applicable, provide the fax number including area code.
6. Fill in the insurance company name that corresponds to your policy.
7. Include a valid email address for correspondence.
8. In the 'Current Agency' section, indicate the name of your existing insurance agency.
9. Input any relevant subcode associated with the current agency, if available.
10. Provide the current producer's name, who is your existing insurance representative.
11. Enter your agency customer ID, which can often be found on previous policy documents.
12. List the named insured, ensuring it matches exactly how it appears on your policy.
13. Enter the policy number(s) for the policies you wish to include under the new agency.
14. Specify the effective date for when the new agent of record will take effect.
15. Indicate the expiration date of the policy.
16. Select the line of business that pertains to the insurance policy.
17. In the designated field, state the name of the new producer, who will be your exclusive representative.
18. Confirm the authorization by signing in the 'Insured's Signature' field.
19. Enter the date of the signature.
20. If applicable, include your title and company name.
21. Provide the street address, city, state, and ZIP code of the insured.
22. Once all fields are completed, save your changes, and you can download, print, or share the form as needed.

Begin completing your Agent Of Record Form Fillable online today for a seamless transition to your new insurance representative.