Get Profmed Intermediary Form

Filling out the Profmed Intermediary Form online can be a straightforward process when guided properly. This guide aims to provide clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Profmed Intermediary Form online.

1. Click ‘Get Form’ button to access the Profmed Intermediary Form and open it in your preferred online document editor.
2. Begin by entering your personal information in the 'Member’s Details' section. Fill in your full names, surname, ID number, and Profmed membership number. Make sure your email address, telephone number, fax number, and cell number are accurately provided.
3. Acknowledge your understanding of the changes by confirming that previous intermediaries will no longer represent you. This is an important step to ensure your records are properly updated.
4. Specify the products associated with the new intermediary by checking the relevant boxes, such as ProPinnacle, ProSecure Plus, ProSecure, ProActive Plus, or ProActive. Make sure you select all that apply.
5. In the 'Intermediary’s Details' section, input the new intermediary's name, broker code, ID number, telephone number, and cell number. Also, provide the intermediary’s email address for correspondence.
6. Record the effective date of the change to ensure all parties are aware of when the new intermediary representation begins.
7. Include the location where you are signing the document, as well as the date of signing. This information helps validate the authorization.
8. Finally, both you and the intermediary need to sign the document in the designated areas to complete the appointment process.
9. Once you have filled out all sections, ensure to save your changes, and proceed to download, print, or share the form as needed.

Complete your Profmed Intermediary Form online today for a smooth transition!