You can open the Insurance Broker Of Record Letter Template in multiple formats, including PDF, Word, and Google Docs.
Insurance Broker Of Record Letter Template Printable | Editable FormSample
Examples
[Name of the Insured]
[Insured’s ID]
[Insured’s Address]
[Insured’s Phone]
[Insured’s Email]
[Name of the Insurance Company]
[Company’s Address]
[Date]
Designation of Insurance Broker of Record
This letter serves as formal notification that we, [Name of the Insured], hereby appoint [Name of the Broker], located at [Broker’s Address], to act as our Insurance Broker of Record.
The Broker has the authority to act on our behalf in all matters pertaining to our insurance needs, including but not limited to assessing risks, obtaining quotes, negotiating terms, and binding coverage.
This appointment is effective as of [Effective Date] and will remain in effect until further notice or until revoked in writing by the Insured.
The Broker agrees to provide the following services: [List specific services].
The Broker shall be compensated as per the agreement made with the insurance company and will provide a transparent breakdown of any commission or fees associated with the services rendered.
Both parties agree to the utmost confidentiality regarding all discussions and documents exchanged in relation to this engagement.
This letter will be governed by the laws of [Jurisdiction].
[Signature of the Insured]
[Name of the Insured]
[Signature of the Broker]
[Name of the Broker]
[Name of the Insured]
[Insured’s ID]
[Insured’s Address]
[Insured’s Phone]
[Insured’s Email]
[Name of the Insurance Company]
[Company’s Address]
[Date]
Appointment of Insurance Broker of Record
We, [Name of the Insured], hereby authorize [Name of the Broker], located at [Broker’s Address], to act as our Insurance Broker of Record, effective immediately.
The Broker is authorized to make representations, obtain quotes, enforce terms, and manage our insurance policies exclusively with our prior consent for any major alterations.
This letter supersedes any previous Broker of Record arrangements made by the Insured. Upon receipt of this letter, please update your records accordingly.
The Broker agrees to provide regular updates, maintain open lines of communication, and pursue the best possible coverage options for the Insured.
The Insured understands that the Broker will be compensated through commissions earned from the insurance placements made on behalf of the Insured.
The Broker agrees to comply with all legal and regulatory requirements, ensuring ethical standards are upheld throughout the brokerage process.
This letter shall be governed by the laws of [Jurisdiction].
[Signature of the Insured]
[Name of the Insured]
[Signature of the Broker]
[Name of the Broker]
Format
Please complete the form below to create the Insurance Broker Of Record Letter Template. All fields must be filled out to ensure a clear and complete agreement. We provide examples to guide you through each step. Insurance Broker Of Record Letter Template 1. Client Information 2. Broker Information 3. Letter Details 4. Scope of Services 5. Authorization Statement 6. Commission Structure 7. Duration of Agreement 8. Signatures and Acceptance 9. Declaration and Signatures
PDF
WORD
Google Docs
Insurance Broker Of Record Letter Template Printable | Editable FormPrintable
