Get the free Broker of Record Authorization Form-093010

Colorado Broker of Record Authorization Form Please submit this completed form by email or fax to Kaiser Permanent Distribution Channels & Broker Relations Department (Licensing & Commissions) at

How to fill out broker of record authorization

How to fill out broker of record authorization:

1. Obtain the necessary form: First, you need to obtain a broker of record authorization form. This form can usually be obtained from your insurance carrier or broker. If you are unsure where to get the form, contact your insurance provider and they will be able to assist you.
2. Provide contact information: The form will typically require you to provide your contact information, including your name, address, phone number, and email. Ensure that you provide accurate and up-to-date information.
3. Specify the insurance policy: Indicate the specific insurance policy for which you are seeking a broker of record change. Include the policy number and any other relevant details.
4. Choose a new broker: In the form, you will need to specify the new broker you wish to appoint as your broker of record. Provide the broker's name, company, address, and contact details.
5. Provide reasons for the change: It is common for the form to ask for the reasons for the broker of record change. Be sure to provide a clear and concise explanation for why you are making this change.
6. Sign and date the form: Once you have completed all the required sections of the form, sign and date it. This ensures that you have provided your authorization for the broker of record change.

Who needs broker of record authorization?

1. Businesses with insurance policies: Any business that has insurance policies, whether it's for property, liability, or any other type of coverage, may need broker of record authorization. This allows them to change their insurance broker and designate a new broker to handle their insurance needs.
2. Individuals with personal insurance policies: Individuals who have personal insurance policies, such as home insurance or auto insurance, may also require broker of record authorization. They may need to change their broker if they are not satisfied with their current broker's services or if they find a better option.
3. Organizations with group insurance plans: Organizations that provide group insurance plans for their employees, such as health insurance or life insurance, may need broker of record authorization. This allows them to designate a new broker to manage the group insurance plans and ensure they are getting the best coverage at the best price.

Overall, broker of record authorization is essential for anyone who wants to change their insurance broker and appoint a new one to handle their insurance needs.

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