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Insurance BOR Document

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INSURANCE BROKER OF RECORD (BOR) AUTHORIZATION

Applicant / Insured Information

Policy Details

Policy Period: From to .

Broker to be Appointed

Coverage Selection (check all that apply)

Exclusions and Limitations

The undersigned acknowledges that this Broker of Record Authorization does not amend, enlarge or replace any policy terms, conditions, endorsements, or exclusions. This authorization does not bind the insurer to provide coverage beyond the terms of the policy in effect. The broker's authority is limited to the matters expressly set forth in this document.

Documentation Checklist

Please provide copies of the following documents to effectuate this authorization. Check those provided:

Beneficiary / Payee Information (if applicable)

Provide any payee or beneficiary designation relevant to premium refund or claims proceeds under the referenced policy(ies). If none, indicate "None."

Broker Authority and Consent

By signing below, the undersigned (the Insured) appoints the named Broker as Broker of Record for the policy(ies) identified above. The Insured authorizes the Broker to receive and inspect records, policy documents, claim information, premium statements, and other information necessary for servicing, negotiating, or renewing the policy(ies). The Insured authorizes the carrier(s) and any prior broker(s) or agent(s) to release such records and information to the named Broker.

This authorization shall remain in effect until the earlier of: (a) receipt by the carrier of a signed written revocation from the Insured, or (b) the effective date of a subsequent Broker of Record Authorization signed by the Insured. The Insured understands that the appointment of Broker does not alter policy coverages, endorsements, terms, or conditions, and nothing in this authorization obligates the carrier to accept any proposed changes to coverage.

Effective Date of Authorization

This authorization is effective as of: Day: Month: Year:

Acknowledgment and Certification

The undersigned certifies that the information provided on this form is true, complete and accurate to the best of their knowledge. The Insured understands that knowingly submitting false or fraudulent information may subject the Insured to civil or criminal penalties under applicable law. The Insured further acknowledges that signing this authorization constitutes written consent for the release of policy and claims information to the named Broker for the purposes described herein.

Check to confirm:

Additional Instructions / Notes

Printed Name:

Signature:

Date:

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What the Insurance BOR Document Is and when it’s used

An Insurance Broker of Record (BOR) document is a signed authorization that designates a named broker or agency to act on behalf of an insured for specified insurance policies. It typically identifies the insured, the outgoing and incoming brokers, policy numbers, the effective date, and any authority limits. Companies use a BOR to change broker representation for renewals, claims handling, or ongoing service; carriers and brokers rely on it to update account records and route commissions accordingly.

Why a clear BOR document matters for insurance relationships

A properly completed BOR clarifies who represents the insured, prevents parallel commission disputes, and creates a clear audit trail for carrier communications and premium billing adjustments. It speeds broker onboarding and reduces administrative friction when policies renew or claims arise.

Why a clear BOR document matters for insurance relationships

Who typically prepares and signs a Broker of Record letter

Ensure signatory authority is confirmed before sending the BOR to the carrier to avoid rejected appointments or commission disputes.

  • Insurance brokers and agencies — Prepare the BOR to document appointment and commission arrangements when acquiring new accounts.
  • Corporate risk managers and benefits administrators — Initiate BORs during renewals or when consolidating broker relationships across policies.
  • Insurance carriers and underwriters — Update policy files and commission routing based on a valid BOR.

Step-by-step: complete and submit a Broker of Record

Follow these sequential steps to prepare, authorize, and route a BOR to the insurer and relevant parties.

  • 01
    Confirm authority: Verify the signer has corporate authority before preparing the BOR.
  • 02
    Populate core fields: Enter insured name, policy numbers, broker details, and effective date.
  • 03
    Sign and date: Obtain authorized signature and printed title; use original signature for carriers requiring wet ink.
  • 04
    Send to carrier: Deliver to the insurer and copy both brokers; confirm carrier receipt and update.

How to configure an online BOR workflow

A consistent digital workflow avoids incomplete submissions and keeps a verifiable audit trail for carriers and brokers.

Field | Configuration Required field | Validation and format
Signer Authentication Email or SMS code; stronger auth for corporate signers
Template Fields Pre-fill insured name, policy numbers, broker contacts
Routing Order Send to insured signer, then incoming broker, then carrier
Notifications Enable email confirmations and completion certificates

Typical e-submission flow for an Insurance BOR

Digital BORs follow a simple prepare-send-sign-confirm cycle that creates a timestamped audit trail for each action.

  • Upload document: Upload the BOR template in PDF or DOCX format.
  • Place fields: Add name, policy, signature, and date fields on the form.
  • Assign signers: Specify the insured signer and any broker recipients in order.
  • Send and confirm: Send the packet and capture a completion certificate for records.

Technical considerations for digital BOR processing

Verify carriers accept electronic BORs and whether they require specific authentication, notarization, or original signed copies; keep audit logs and delivery receipts for compliance and commission reconciliation.

  • Document formats: PDF and DOCX are standard for carrier intake.
  • Integrations: CRM and document storage integrations speed routing and archiving.
  • Authentication: Email, SMS, or stronger verification as required by carrier policy.

Core components of a professional Insurance BOR Document

A complete BOR should unambiguously establish representation, set an effective date, and provide contact and authorization details required by carriers.

Clear appointment clause

State explicitly that the insured appoints the incoming broker as Broker of Record for specified policies and list any limits or exclusions to that appointment.

Policy identifiers

Include each applicable policy number, line of coverage, and the insurer name so carriers can update the correct accounts without manual follow-up.

Broker contact and license

Provide incoming broker name, address, NPN or license number, phone, and email to satisfy underwriting and commission routing requirements.

Commission and fees note

Document any commission arrangements or fee assignments to reduce later disputes between incoming and outgoing brokers.

Authorized signature

Identify the signer, printed name, title, and date; include corporate seal or notary if the carrier demands original execution.

Carrier notice instructions

Specify how carrier notice should be provided and include copies to outgoing broker and insured administrative contacts for transparency.

Security, compliance, and audit items to include or verify

In-transit encryption: TLS 1.2/1.3
At-rest encryption: AES-256
Audit trail: Timestamped action log
ESIGN / UETA: Legal e-sign compliance
HIPAA (if applicable): BAA required for PHI
Access controls: Role-based access and SSO

Common pitfalls when preparing a Broker of Record

  • Using an informal or ambiguous statement of appointment that carriers cannot process and therefore reject.
  • Omitting exact policy numbers or listing expired policies, causing delays in carrier record updates.
  • Failing to confirm the signer’s authority within the insured organization, which can void the BOR.
  • Not copying the outgoing broker or carrier contact list, which can lead to commission disputes or missed notifications.

Risks and consequences of an incorrect or incomplete BOR

Coverage gaps: Claim denials risk
Commission disputes: Payment interruptions
Regulatory exposure: Compliance inquiries possible
Contract invalidation: Carrier may reject appointment
Delays in servicing: Renewal processing backlog
Data privacy risk: Improper PHI handling

Key timing considerations and common deadlines

Timing affects when a broker’s authority begins and when carriers will act; follow carrier-specific deadlines and policy renewal windows.

Effective Date Entry:

Enter as MM/DD/YYYY; carrier action is typically on or after this date.

Carrier Notice Window:

Many insurers require prompt notice; confirm carrier-specific timing to avoid processing delays.

Renewal Periods:

Submit BORs well before renewal offers to ensure broker placement during negotiations.

Recordkeeping Deadline:

Retain executed BOR per company retention policy and regulatory minimums.

Revocation Timing:

Revocations take effect per carrier policy; provide clear written notice and timestamp.

Milestone timeline from preparation to carrier update

A concise sequence of milestones helps stakeholders track progress and confirm carrier acceptance.

01

Prepare BOR

Populate insured, policy numbers, brokers, and effective date.

02

Authorize Signature

Obtain signature from an authorized officer or agent.

03

Submit to Carrier

Send BOR and request written confirmation of appointment.

04

Confirm Update

Verify carrier updated policy records and commission routing.

Typical eSignature vendor comparison for processing an Insurance BOR

Compare common platform features and starting prices for eSignature providers commonly used to execute BOR documents; signNow is listed first per standard vendor comparisons.

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 Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No envelope cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Real-world examples of BOR use and outcomes

Two practical examples show how digital execution and clear BOR language reduce friction during renewals and servicing changes.

Martin Properties — Tim Martin

Martin Properties moved broker representation for multiple commercial leases to a new agency to consolidate service.

  • The change reduced vendor contacts during renewals.
  • "I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently."

Fertility Centers — John Butler

A healthcare provider used a BOR to transfer broker services across several benefit plans efficiently.

  • Documentation included HIPAA controls and a privacy addendum.
  • "The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."

Frequently asked questions about Insurance BOR Documents

Answers to common questions about validity, signatures, revocation, and electronic submission of Broker of Record documents.


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