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Agent of Record (Broker of Record) Letter Template (Simple)

Appoint a new insurance agent or broker to service your existing policies, replacing the current agent.

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SimpleFullPlain-English Summary

Simple: a 1–2 page short form with just the core terms.

This template is not legal advice; consult a licensed attorney in your state. Insurance is regulated state by state: some states restrict assignments of benefits and direction-to-pay forms, require specific claim or cancellation notices, or require a licensed agent or adjuster. Your insurer may also require its own form.
E-Sign Auto is not a law firm and does not provide legal advice.

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1. Parties2. Details 1/23. Details 2/2

Parties

Signing order: Insured → New Agent / Agency (acceptance). Each signer is invited after the previous one signs.

1. Insured
2. New Agent / Agency (acceptance)

Signature, date and name fields are added for every signer automatically.

Details 1/2

Details 2/2

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Signature, initials (every page) and date fields are placed for each party. You can review and adjust them before sending.

Live preview

What the sections mean (plain English)
REPLACES PRIOR AGENT
What the person acting for someone else is allowed to do.
AUTHORITY
What the person acting for someone else is allowed to do.

How to use this Agent of Record (Broker of Record) Letter template

  1. Answer the guided questions. Your name and company fill in automatically from your profile.
  2. Pick the governing state and complete the [STATE-SPECIFIC] blanks. Switch optional clauses on or off.
  3. Check the live preview, then create the document. Signature, initial and date fields are placed for each party.
  4. Review the fields and send. Each party signs in order, and everyone gets the signed PDF.

Frequently asked questions

Is this Agent of Record Letter template free?

Yes. You can fill it in, download it and send it for electronic signature with a free E-Sign Auto account.

Is an electronically signed Agent of Record Letter legally binding?

In the U.S., the federal ESIGN Act and state UETA laws generally give e-signatures the same effect as handwritten ones. Check your state's rules.

Does this template work in my state?

It is a generic, state-neutral starting point. Pick your governing state and complete every blank marked [STATE-SPECIFIC]. This template is not legal advice; consult a licensed attorney in your state.

Who signs, and in what order?

Insured, then New Agent / Agency (acceptance). Each signer gets a secure link in that order, with signature, initial and date fields already placed.