Get Agent Of Record Form - Kaiser Permanente - Brokernet Kp

Completing the Agent Of Record Form for Kaiser Permanente is a straightforward process that ensures your insurance agent is authorized to act on your behalf. This guide provides clear steps to assist you in accurately filling out the form online.

Follow the steps to complete the Agent Of Record Form easily.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by filling in the member's information, including their full name and contact details in the designated fields. This information must be accurate to ensure proper identification with the insurance carrier.
3. Next, locate the section where you will input the insurance agent's information. This includes the agent's name and agency name. Ensure that the information matches the details held by Kaiser Permanente.
4. In the designated field, provide the agency number. This number is crucial for proper identification and verification within the insurance system.
5. Sign the form in the member signature field to authorize the insurance agent to act on your behalf. Also, date the signature to indicate when the authorization was provided.
6. The insurance agent must then complete their section by confirming that they have not made any unauthorized representations and that all provided information is accurate. They should sign and date the form accordingly.
7. Once all fields have been filled out completely, save any changes made to the document. You may then choose to download, print, or share the completed form as needed.

Complete and submit your Agent Of Record Form online today for efficient processing.