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`CLIENT INFORMATION FORM Company Profile Legal Name of Organization: ___Broker of Record: ___Mailing Address: ___ City: ___State: ___ Zip: ___Website URL: ___Employer Fed Tax ID#: ___# of Years in

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How to fill out broker of record

01

Obtain the appropriate broker of record form from the insurance agency or company.

02

Fill in your personal information such as name, address, and contact details.

03

Include details about your current insurance policies and the reason for wanting to change brokers.

04

Sign and date the form to make it legally binding.

05

Submit the completed form to the insurance agency or company for processing.

Who needs broker of record?

01

Individuals or businesses who want to change their insurance broker and transfer their policies to a new broker.

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What is broker of record?

Broker of record is an individual or company designated by an insured to represent them with an insurance provider.

Who is required to file broker of record?

The insured party is required to file a broker of record.

How to fill out broker of record?

To fill out a broker of record, the insured must submit a written request to their current insurance provider and the new broker they wish to designate.

What is the purpose of broker of record?

The purpose of broker of record is to officially designate a new insurance broker to represent the insured party.

What information must be reported on broker of record?

The broker of record form typically requires information such as the insured's name, policy number, current broker information, and new broker information.

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