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ATTACHMENT C AGENT/BROKER ACKNOWLEDGMENT FORM In the performance of my duties as a CBA or Subagent for Event, I hereby acknowledge the following: 1. I received and have been educated, on an annual
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Step 1: Obtain a copy of the attachment c agent/broker acknowledgment form.
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Step 2: Read the form carefully to understand the information required.
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Step 3: Fill in your personal details such as name, address, and contact information in the appropriate sections.
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Step 4: Provide your agent/broker details, including their name, contact information, and license information.
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Step 5: Review all the information filled out to ensure accuracy and completeness.
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Step 6: Sign and date the form to acknowledge your understanding and agreement.
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Step 8: Submit the filled-out form to the relevant authority or organization as required.

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Health insurance policy applicants who are using an agent or broker to assist them in the application process.
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Insurance companies or organizations that request the attachment c agent/broker acknowledgment form as part of their application or enrollment process.
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Attachment C Agent/Broker Acknowledgment is a form used to acknowledge the agreement between the agent/broker and the principal.
The agent/broker is required to file attachment C agent/broker acknowledgment.
To fill out attachment C agent/broker acknowledgment, the agent/broker must review the terms of the agreement, sign and date the form.
The purpose of attachment C agent/broker acknowledgment is to confirm the understanding and acceptance of the terms outlined in the agreement.
The information reported on attachment C agent/broker acknowledgment includes the name of the agent/broker, date of agreement, and signature.
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