ACORD 36 Insurance Form – Broker/Agent of Record Change

ACORD 36 (2007/01)

Agent/Broker of Record Change

Form Number:

ACORD 36 (2007/01)

Category:

Authorization Forms

Last Updated:

January 2007

Page Count:

01 page

File Format:

PDF, Fillable PDF

Acord 36 PDF Fillable Form

If you are not satisfied with the assistance of your insurance agent or broker, you can request that the insurer change the agent. The Acord 36 form fulfills the insurance industry requirements for changing an insurance policy’s agent or broker record. The information provided on the form ensures transparency between the policyholder, agent, and insurer.

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Benefits of the Acord 36 Fillable

Ensures Agent Transitions

It ensures changing the agent record without manipulating the personal (Home, Auto) or commercial policies.

Mitigates Liability Risks

The accurate and concise information on the form avoids errors in policy servicing responsibilities.

Ensure Contractual Compliance

Maintains the insurer agreement requirements to avoid breach of contract during the agent transitions.

Accommodates Relocations

Helps the policyholder to change the current agent when moving to a new region.

Key Sections of the Acord 36 Printable Form

Agency Details

Provides the record of a new agent or broker for transparent communication. The insurers can verify the agency’s involvement for a smooth transition.

Insurance Company Details

Contains the insurance company’s details and identifies the insurer underwriting the policy.

Policy Information

Includes the insurance policy record for which the broker or agent is being changed. It helps insurers to verify the correct policy status.

Current Agent/Broker Information

Verifies the details of the current agent or broker managing the insurance policy.

New Agent/Broker Information

Informs the insurer of the new agent or broker who will be responsible for managing the insurance policy.

Signature

The authorized representative’s signature validates the form for a legal request to change the agent or broker record.

How to Fill Out the Acord 36 Agent/Broker of Record Change Form?

  1. Write the name, address, phone number, fax number, customer ID number, and email address of a new agent.
  2. Write the name and address of the current insurance company.
  3. Mention the policyholder’s name, policy number, effective date, expiration date, and line of business (personal or commercial).
  4. Write the new producer’s name and code, and mention the date.
  5. Get the insured’s signature and mention the date.
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Frequently Asked Questions

An individual or business with an active insurance policy can use the form to change the insurance agent.

Accurately completing the form ensures smooth transitions of the agent or broker record, maintaining coverage continuity.

Yes, it ensures the coverage of personal (home, auto) and commercial (liability, property) policies.

It ensures that the insurer changes the agent record to the correct policy, avoiding errors.

The request’s cancellation depends on the processing status. However, contact your insurer or current agent immediately and ask for the cancellation.

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