Who must sign the BOR request?

The policyholder must sign. Some carriers may also require the outgoing broker's written release or the incoming broker's appointment; check carrier-specific requirements before submission.

Can the request be e-signed?

Yes. Electronic signatures meet ESIGN and UETA standards when intent, consent, attribution, and reliable record retention are present. Consumer-facing disclosures may be required for some transactions.

What if the incoming broker lacks a license?

Carriers typically verify producer licensing before appointment. If the incoming broker is unlicensed, the carrier may reject the request or delay appointment until licensing is confirmed.

How do I confirm commission routing?

Request written confirmation from the carrier after appointment. Keep copies of the carrier's appointment notice and any commission statements for reconciliation.

Is notarization ever required?

Notarization requirements vary by carrier and state. Some carriers accept signatures without notarization; others require a notarized broker appointment or release.

What if the carrier requests more information?

Respond promptly with the requested documents—license numbers, agency appointment letters, or additional signatures—to avoid processing delays or effective-date changes.

Electronic Signature
Templates
Insurance
Insurance BOR Change Request

Insurance BOR Change Request

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Insurance BOR Change Request

Client Name: Policy Number:

Insured / Applicant Information

Insured Name

Date of Birth

Address

Telephone

Email

Entity Type (select all that apply)

Individual Corporation LLC Trust Other

Current Broker of Record

Broker Firm Name Broker Contact

Broker License / Agency Code

New Broker to be Appointed

Broker Firm Name Broker Contact

Broker License / Agency Code

Policy Details

Insurance Carrier

Policy Number

Policy Period From

Policy Period To

Coverage / Limit

Deductible

Premium

Coverage Types (select all that apply)

Property General Liability Commercial Auto Workers' Compensation Professional Liability Umbrella Cyber Other

Requested Change and Attachments

Requested Effective Date:

Reason for Change Attachments (check all included)

Current policy declaration page
Proof of authority to sign (if entity)
Broker appointment letter from new broker
Other supporting documentation

Exclusions, Known Claims, and Material Information

Known Exclusions / Endorsements Have there been any claims or circumstances that might give rise to a claim?

Yes No

If yes, provide details

Beneficiary Information (if applicable)

Complete beneficiary information only where policy requires a beneficiary designation.

Primary Beneficiary 1 - Name

Primary Beneficiary 2 - Name

Contingent Beneficiary - Name

Declaration and Authorization

I hereby authorize the insurer named above to accept this Broker of Record change request. I appoint the New Broker named in this request as my exclusive broker of record for the policy listed above and revoke any prior Broker of Record appointment for the same policy effective on the Requested Effective Date indicated on this form or on such other date accepted by the insurer.

I authorize the insurer and its representatives to release policy information, including premium, coverage, loss history, and claims information, to the newly appointed broker for purposes of servicing, endorsements, renewals, and premium accounting. This authorization does not alter coverage terms, premium obligations, or policy effective dates unless formally endorsed by the insurer.

I represent and warrant that I am the named insured or an authorized representative of the insured with the authority to execute this change. If signing on behalf of an entity, I certify that I hold the requisite corporate or organizational authority to bind the insured and that required corporate resolutions or other proof of authority have been or will be provided upon request.

I understand that changes to broker appointment may affect commission arrangements between the insurer and brokers. This BOR change request is a designation of broker of record only; it is not a request to cancel coverage. The insurer's acceptance of this designation is required to effect the appointment.

Certification

By signing below I certify under penalty of perjury that the information provided in this Insurance BOR Change Request is true, correct, and complete to the best of my knowledge. I acknowledge that any willful misstatement of material fact may be subject to penalties under applicable law.

Applicant Name:

Signature:

Date:

What the Insurance BOR Change Request Is

An Insurance BOR Change Request is a written authorization that transfers the broker-of-record status for an insurance policy from one broker or agent to another. It documents the policyholder's instruction to the insurer to redirect communications, billing, and commission handling to the newly designated broker. The form typically names the insured, the outgoing broker, the incoming broker, the policy or account number, and an effective date. Carriers use the signed request to update agency appointments and commission records and to establish the new broker as the policyholder's representative.

Why a Clear BOR Change Request Matters

A correct BOR Change Request prevents coverage administration delays, ensures commission routing is accurate, and creates an auditable record of the policyholder's direction to the insurer. Properly executed requests protect all parties from disputes over representation or payment.

Who Typically Prepares and Signs This Request

The form is used by policyholders, current brokers, and incoming brokers to document a change in representation.

Policyholders — Individuals or organizations that instruct the insurer to change broker representation and must authorize the transfer in writing.
Current Brokers — May submit release paperwork or confirm termination of their broker-of-record status per agency agreements and carrier rules.
Incoming Brokers — Provide appointment details, contact information, and may submit the request to the insurer to effect the change.

All signatories should confirm license status and any carrier-specific appointment requirements before submitting the request.

Step-by-Step: Submitting a BOR Change Request

Follow these steps to prepare and submit a complete request that carriers can process without rework.

01

Prepare Form: Complete all fields accurately.
02

Gather Authorization: Obtain signatures from the policyholder and, if required, the outgoing broker.
03

Submit to Carrier: Send via the carrier's accepted channel.
04

Confirm Appointment: Verify carrier confirmation and commission assignment.

How to Configure an Online BOR Change Workflow

A streamlined digital workflow reduces manual steps and preserves an audit trail for the carrier and brokers.

Field	Recommended Setting
Authentication	Email + SMS code for policyholder verification
Notifications	Automatic emails to outgoing and incoming brokers
Conditional Fields	Show outgoing broker release only when applicable
Attachments	Allow agency appointment letters and license PDFs

Where to Send the Completed BOR Change Request

Carriers and agencies accept these requests through several channels; choose the one the insurer prefers to avoid processing delays.

Carrier Portal: Upload via the insurer's secure online portal
Email Submission: Send to the carrier's designated intake address
Agency Management System: Submit through integrated agency portals or broker dashboards
Postal or Fax: Use only when required by the carrier's policy

Digital Signing and Technical Requirements

Digital submission is common; ensure the platform you use supports required authentication and preserves an audit trail.

File Formats: PDF or PDF/A preferred for compatibility
Authentication: Email plus SMS or ID proofing recommended
Audit Trail: Timestamp, IP, and signer events recorded

Use integrations with agency management systems or carrier portals where available to simplify delivery and reduce manual uploads.

Typical Timelines and Processing Expectations

Processing timelines vary by carrier and state; use these common timeframes to set expectations with clients and brokers.

Request Receipt:

Carrier acknowledges receipt within 1–5 business days

Verification Period:

Carrier verifies authorization and broker licensing in 3–10 business days

Appointment Update:

Incoming broker appointment recorded in 5–15 business days

Effective Date:

Effective date follows policy terms or the date specified

Commission Adjustment:

Commission routing updated per carrier billing cycle

Key Milestones from Request to Appointment

Major milestones help you track progress and escalate when processing exceeds expected windows.

01

Submit Complete Request

All fields, signatures, and attachments uploaded to carrier

02

Carrier Validation

Carrier confirms identity and broker licenses

03

Appointment Recording

Insurer updates agency and commission systems

04

Client Notification

Policyholder and brokers receive confirmation

Common Mistakes That Slow Processing

Incomplete policy identifiers or numbers that prevent the carrier from locating the policy and halt processing.
Missing signatures or lack of explicit outgoing broker release when the carrier requires dual authorization.
Submitting via unsupported channels or incorrect email addresses that cause delays or misrouting of requests.
Incorrect license or producer numbers for the incoming broker that fail carrier license verification checks.

Risks and Potential Consequences of an Incorrect Request

Coverage Gap: Risk of missed notices

Commission Dispute: Payment allocation conflicts

Regulatory Action: State DOI complaints possible

License Issues: Unlicensed brokering risks

Contractual Breach: Agency agreement violations

Delayed Claims: Claim notices may be delayed

Required Information and Security Controls

Policy Identifiers: Policy number, type

Names: Full legal names

Broker IDs: Producer/license numbers

Contact Details: Phone, email, address

Signatures: Handwritten or e-sign

Encryption: AES-256 at rest

Comparing eSignature Options for BOR Change Requests

Vendor pricing and features influence ongoing costs; this table highlights starting prices and select capabilities for common eSignature providers.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, submitting, and validating an Insurance BOR Change Request.

Need help? Contact support

Who must sign the BOR request?
The policyholder must sign. Some carriers may also require the outgoing broker's written release or the incoming broker's appointment; check carrier-specific requirements before submission.
Can the request be e-signed?
Yes. Electronic signatures meet ESIGN and UETA standards when intent, consent, attribution, and reliable record retention are present. Consumer-facing disclosures may be required for some transactions.
What if the incoming broker lacks a license?
Carriers typically verify producer licensing before appointment. If the incoming broker is unlicensed, the carrier may reject the request or delay appointment until licensing is confirmed.
How do I confirm commission routing?
Request written confirmation from the carrier after appointment. Keep copies of the carrier's appointment notice and any commission statements for reconciliation.
Is notarization ever required?
Notarization requirements vary by carrier and state. Some carriers accept signatures without notarization; others require a notarized broker appointment or release.
What if the carrier requests more information?
Respond promptly with the requested documents—license numbers, agency appointment letters, or additional signatures—to avoid processing delays or effective-date changes.

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