Get the free Broker of Record Form - Washington Health Foundation - whf

Broker of Record Form Washington Health Foundation Washington Office of the Insurance Commissioner #773469 Three easy steps for the commissions currently included in your health insurance premiums

How to fill out broker of record form

How to Fill Out Broker of Record Form:

1. Begin by obtaining the broker of record form from the appropriate insurance agency or broker entity.
2. Enter your personal information, including your name, address, phone number, and email address. This helps the agency identify and contact you regarding the form.
3. Provide details about your current insurance policy, such as the policy number, effective dates, and the name of the insurance carrier. This information helps to determine the existing policy that you want to transfer to a different broker.
4. Indicate the reason for your request to change brokers, whether it's due to unsatisfactory service, the desire for better coverage, or any other relevant reason.
5. If applicable, include the name and contact information of the broker you wish to appoint as your new broker of record.
6. Sign and date the form, ensuring that all the information provided is accurate and complete.
7. Obtain any necessary signatures or approvals from your current insurance carrier or agent, as some companies require their consent for the change of broker.
8. Submit the filled-out broker of record form to the insurance agency or broker according to their specified method, such as mailing, faxing, or submitting it electronically.

Who needs broker of record form:

1. Businesses or individuals who currently hold insurance policies and wish to switch their insurance broker may need to fill out a broker of record form.
2. Insurance agencies or brokers who are seeking to become the new broker of record for a client's insurance policies may also require a completed broker of record form.
3. Some insurance carriers or regulatory bodies may require the completion of a broker of record form when changing brokers to ensure proper documentation and accountability in the insurance market.

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What is broker of record form?

Broker of record form is a document that designates a specific insurance broker as the official representative of the policyholder.

Who is required to file broker of record form?

Policyholders who wish to change their insurance broker must file a broker of record form.

How to fill out broker of record form?

To fill out a broker of record form, policyholders must provide their current insurance policy information, details of the new broker, and sign the form.

What is the purpose of broker of record form?

The purpose of broker of record form is to officially designate a new insurance broker to represent the policyholder.

What information must be reported on broker of record form?

The broker of record form typically requires policyholder's name, current policy details, new broker's information, and signatures of all parties involved.