Acord Form Agent Of Record - Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective. 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 Policy number(s) effective date expiration. 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. Using acord's standardized forms allows for increased efficiency, accuracy, and speed of information processing. 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. 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 36 (1/98) oc acord corporation 1996 date producer insurance company name code:
Policy number(s) effective date expiration. Web agent/broker of record change please be advised that we wish to name as our exclusive representative effective. Web since our first paper form was released in 1971, acord has provided the standard forms used by the insurance industry. 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. Acord 36 (1/98) oc acord corporation 1996 date producer insurance company name code: 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 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.