Get Compensation-disclosure Form (fee-disclosure Form) (pdf, 94kb) - Insurance Wa

Filling out the Compensation-disclosure Form is an essential step for individuals engaging with insurance producers. This guide will provide you with clear, step-by-step instructions to complete the form accurately and efficiently online.

Follow the steps to fill out the form online successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the agency or producer's name in the designated field labeled ‘AGENCY/PRODUCER’.
3. Enter the name of the insured or client in the field labeled ‘INSURED/CLIENT’.
4. Proceed to Part 1 if the Licensed Producer's compensation is strictly from charging a fee. Check the appropriate box and specify the amount charged in the provided space.
5. If the compensation includes both a fee and a commission, go to Part 2. Check the relevant box and enter the fee amount and the commission amount in their respective fields, along with the name of the insurer. Provide a brief explanation of how any fee offset works, if applicable.
6. In Part 3, indicate whether the Licensed Producer may receive additional commissions. Check the box and read the explanation regarding contingent commissions. Provide any requested information if required.
7. Sign and date the form in the respective fields for both the insured and the producer.
8. Once you have completed all sections, make sure to save changes, download a copy for your records, print the form, or share it as necessary.

Complete your Compensation-disclosure Form online easily and efficiently today!