HTML Preview Insurance Agent Appointment Letter page number 1.
SAMPLE
AGENT/BROKER OF RECORD LETTER
(TO BE SUBMITTED ON GROUP LETTERHEAD ONLY)
Date (IMPORTANT)
<Name of Broker Program Manager>
Broker Program Manager
<Company Name>
<Company Street Address>
<Company City, State, Zip>
Dear <Name of Broker Program Manager>:
This is to notify you that our company has appointed (name of agent), whose business
address is (street, city, state, zip code) as our sole insurance representative, with
respect to coverage provided to this organization by <Insert Company Name>effective
(month, date, year). I have authorized (him/her to act on my behalf in place of (former
agent/broker name) whose business address is (street, city, state, zip code). (This
sentence only needed if replacing former agent).
I understand that if our company elects to purchase coverage from your company that
<Name of Agent> may be entitled to base and/or bonus compensation for our business.
This designation will remain in effect until we notify <Insert Company Name> in writing
to the contrary.
Sincerely,
__
Signature of Company Officer Please print (Officer Name)
___
Title of Company Officer
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