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acord agent of record
acord agent of record

Fillable AGENT/BROKER OF RECORD CHANGE - pmtins .com

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ACORD TM DATE AGENT/BROKER OF RECORD CHANGE PRODUCER INSURANCE COMPANY NAME CODE AGENCY CUSTOMER ID SUBCODE POLICY NUMBER S EFFECTIVE DATE EXPIRATION DATE Please be advised that we wish to name LINE OF BUSINESS as our exclusive representative effective for the lines of business shown above currently in force or submitted by application. This authorization replaces any other authorization that may have been ...
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