Get Accord36 Broker Of Record Form

Filling out the Accord36 Broker Of Record Form online is an essential step for ensuring that your insurance representation accurately reflects your current needs. This guide will provide you with a clear set of instructions to assist you in completing this form efficiently.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Start by entering the date in the specified format (MM/DD/YYYY) at the top of the form.
3. In the 'New Agency' section, input the name of the new agency that you wish to designate as your Broker of Record.
4. Provide the phone number and fax number of the new agency in the designated fields, including area codes.
5. Next, fill out the 'Insurance Company Name' field with the name of the insurance company you are working with.
6. In the 'Current Agency' section, include the current agency's details, such as the name, code, and producer information, if applicable.
7. Enter the 'Agency Customer ID' if you have one assigned to you by the current agency.
8. Complete the 'Named Insured' section by entering the name as it appears on the policy.
9. Fill in the policy number(s) associated with the coverage you are designating under this authorization.
10. Provide the effective date and expiration date for the authorization you are granting.
11. Specify the line of business for which this authorization is applicable.
12. In the 'Producer' field, write the name of the person you wish to designate as your exclusive representative.
13. Indicate the effective code number and date of this designation.
14. Ensure that the authorization replaces any previous authorizations by making that statement clear.
15. Finally, the insured must sign and date the form, and if applicable, provide their title and company name along with their street address, city, state, and zip code.
16. Once you have completed all fields, review your entries for accuracy. Save changes, download, print, or share the form as needed.

Complete your Accord36 Broker Of Record Form online today to ensure accurate insurance representation.