Acord Agent Of Record Form - Web agent/broker of record change date (mm/dd/yyyy) policy number(s) effective date expiration date named insured line of business (as it appears on policy) please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted by application. Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective. Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted. Acord forms are now available in a variety of formats, including printable pdf, electronic fillable, and eforms. Using acord's standardized forms allows for increased efficiency, accuracy, and speed of information processing. Policy number(s) effective date expiration. The acord name and logo are registered marks of acord acord 36 (2007/01) new agency current agency current producer policy number(s) effective date expiration date named insured line of business Acord 36 (1/98) oc acord corporation 1996 date producer insurance company name code: Web since our first paper form was released in 1971, acord has provided the standard forms used by the insurance industry.
The acord name and logo are registered marks of acord acord 36 (2007/01) new agency current agency current producer policy number(s) effective date expiration date named insured line of business Acord 36 (1/98) oc acord corporation 1996 date producer insurance company name code: Policy number(s) effective date expiration. Acord forms are now available in a variety of formats, including printable pdf, electronic fillable, and eforms. Web since our first paper form was released in 1971, acord has provided the standard forms used by the insurance industry. Using acord's standardized forms allows for increased efficiency, accuracy, and speed of information processing. Web agent/broker of record change date (mm/dd/yyyy) policy number(s) effective date expiration date named insured line of business (as it appears on policy) please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted by application. Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted. Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective.