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AGENT OF RECORD LETTER Date / / Mrs. Janice Blackburn Telehealth P. O. Box 30192 Salt Lake City, UT 84130-0192 Dear Mrs. Blackburn: hereby designates Company Name / Month Year as Agent of Record,
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How to fill out an agent of record letter:

01
Begin by addressing the letter to the appropriate recipient. This is typically the insurance company or organization that requires the agent of record letter.
02
Include your contact information at the top of the letter, including your name, address, phone number, and email address.
03
Clearly state the purpose of the letter, which is to designate a specific agent or agency as the official agent of record for your insurance policy.
04
Provide the details of the agent or agency you are designating. Include their name, contact information, and any relevant license or certification numbers.
05
Clearly state your intention to allow this agent or agency to represent your interests regarding your insurance policy. This could include making changes, submitting claims, or handling any other policy-related matters.
06
Sign and date the letter. It is important to include your full legal name and to use your signature as it appears on your insurance policy documents.
07
Keep a copy of the letter for your records before sending it to the appropriate recipient.

Who needs an agent of record letter?

01
Individuals or businesses who wish to designate a specific insurance agent or agency to represent them for a specific policy or policies may need an agent of record letter.
02
This can be useful in situations where you want to consolidate your insurance policies, work with a trusted agent, or simplify communication by having a single point of contact for your insurance needs.
03
Insurance companies or organizations may require an agent of record letter to formalize the appointment of a designated agent or agency for certain policies. This allows them to have a clear understanding of who is authorized to act on behalf of the policyholder.
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The agent of record letter is a document that designates an individual or entity as the official representative for an insurance policy.
Policyholders or insurance brokers may be required to file an agent of record letter depending on the insurance company's policies.
The agent of record letter typically requires the policyholder to provide their information, the new agent's information, and a signature authorizing the agent to act on their behalf.
The purpose of the agent of record letter is to officially designate a new agent to manage an insurance policy on behalf of the policyholder.
The agent of record letter must include the policyholder's name, policy number, effective date of designation, new agent's information, and signature of the policyholder.
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2013 2010 Utah SelectHealth 1069R Blackhurst DeSpain despainselecthealth rescinds submittal Janica SelectHealths designates Attn contractual designation representations inducement letterhead herein Solicit UT commissions achieving payable issuing org empl

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