Can a BOR be signed electronically?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the parties demonstrate intent, consent, attribution, and record retention capability.

Do carriers require notarization?

Most carriers do not universally require notarization for a BOR, but individual insurers or state rules may request notarized signatures or witness lines; confirm carrier-specific requirements before submission.

What if the carrier rejects the BOR?

If rejected, carriers typically provide a reason; correct errors, supply requested proof of authority, and resubmit. Retain rejection notices and correspondence for audit trails.

Who must sign for a corporation?

An authorized corporate officer or individual with delegated authority should sign. Carriers may request a corporate resolution or power of attorney to verify signing authority.

How should I submit supporting documents?

Attach agency license, prior broker termination, or resolutions as required. Use PDF attachments with clear filenames and maintain an audit trail of submissions and acknowledgments.

Yes. A revocation or replacement BOR should be signed by the insured and submitted to carriers; processing timelines vary and carriers may require additional documentation to accept revocation.

Electronic Signature
Templates
Insurance
Insurance Broker of Record

Insurance Broker of Record

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INSURANCE BROKER OF RECORD AUTHORIZATION

Applicant / Insured Information

Insured / Named Entity:

Entity Type (select applicable): Individual Corporation LLC Partnership Trust Other

Mailing Address:

Contact Phone:

Email:

Date of Birth (if individual):

Current Policy Information

Insurer: Policy No.:

Policy Period: From to

Coverage Limits / Summary:

Deductible / SIR:

Annual Premium:

Additional Policies / Carriers (if applicable):

Coverage Lines to be Represented

Select the coverages for which the broker of record will be authorized to receive documents and act as producer of record:

Property General Liability Commercial Auto Workers' Compensation Professional Liability Cyber / Technology Umbrella / Excess Other:

Broker Information

Broker / Agency Name:

Primary Broker / Contact:

License Number:

Broker Address:

Broker Phone:

Broker Email:

Broker Fax:

Broker of Record Effect & Scope

Effective Date for Broker of Record designation:

Scope of Authority (check all that apply): the named broker is authorized to:

Receive policy documents, certificates and renewals Request endorsements and policy changes Negotiate terms and coverage proposals Authority to settle claims (requires separate written delegation) Obtain loss and claims history

Exclusions and Limitations

The insured expressly acknowledges the following limitations unless expressly granted in writing:

Broker is NOT authorized to adjust, accept or settle claims without separate written authority. Broker is NOT authorized to bind coverage on behalf of insurer unless insurer provides written confirmation. Changes to commission or compensation arrangements require insurer and insured approval and separate written agreement. Access to closed claims files or privileged investigative materials may be withheld by insurer; insurer discretion applies. Other limitations:

Compensation / Commissions

The insured understands that commission and fee arrangements between broker and insurer, or between broker and insured, are commercial matters separate from this authorization. The insured authorizes the broker to receive customary commissions and fees from insurers unless otherwise stated below.

Compensation Notes (if any):

Authorization and Release

By executing this Broker of Record Authorization, the insured hereby appoints the named broker/agency as broker of record for the policy(ies) identified above and authorizes all insurers, managing general agents, current brokers and producers, and their representatives to furnish the named broker with policy declarations, endorsements, premium statements, claim and loss information, underwriting files, certificates of insurance, and other information as permitted by law.

This authorization directs any prior broker of record and any insurer to accept the named broker as the producing broker of record for the lines of coverage checked above and to release information necessary for the effective placement, servicing and renewal of coverage. This Broker of Record supersedes any prior broker of record designation for the coverages and policies specifically referenced herein, unless otherwise stated in writing.

The insured represents and warrants that the signer has full authority to execute this authorization on behalf of the insured. The insured agrees to indemnify and hold harmless the broker for actions taken in reliance on this authorization, except for the broker's willful misconduct or gross negligence.

Duration, Revocation & Notices

This authorization remains in effect until the earlier of: (a) the effective date of a written revocation delivered by the insured to the insurer and broker; (b) replacement by a subsequent Broker of Record authorization; or (c) termination of the referenced policy. Revocation is effective upon receipt by the insurer or broker. Notices required under this authorization must be in writing and addressed to the broker and insurer at the addresses provided above.

Beneficiary / Related Designation (Optional)

Where applicable to life or personal insurance products, list any beneficiary designation or related contact for policy servicing:

Beneficiary Name:

Relationship to Insured:

Percentage:

Insured Certification

The undersigned certifies that the statements and information contained in this authorization are true and that the undersigned is authorized to execute this Broker of Record authorization on behalf of the insured named above. The undersigned understands that execution of this authorization does not amend or change insurance coverage or policy terms; such changes require acceptance by the insurer.

Applicant Name:

By (Signature):

Date:

What an Insurance Broker of Record Is and how it functions

An Insurance Broker of Record (Broker of Record or BOR) is a written authorization that designates a specific insurance broker to represent a policyholder with one or more insurers. The BOR notifies carriers that the named broker is authorized to request policy information, handle renewals, submit endorsements, and manage claims communications on the insured's behalf. A BOR does not change contract terms or transfer coverage by itself; it documents the insured's choice of professional representative and supports carrier intake and premium routing procedures.

Why a Broker of Record matters for policy control and clarity

A clear Broker of Record reduces ambiguity about who may access policy details, submit endorsements, or receive premium notices. It centralizes communications, creates an auditable record of broker appointment, and supports faster carrier response where insurers require documented broker authorization under their internal procedures.

Who typically prepares and signs a Broker of Record

Common parties that prepare or request a Broker of Record include businesses, individual policyholders, and internal risk teams seeking formal broker appointment.

Commercial policyholders needing centralized account and renewal management across multiple lines of coverage.
HR or benefits administrators who appoint brokers for group health, workers' compensation, or employee benefits.
Independent brokers or agents documenting a new appointment or a change in broker representation with a carrier.

Identifying the initiating party helps determine signing authority, required attachments, and whether carrier-specific acceptance forms are needed.

Typical signer roles and their responsibilities

Risk Manager

A risk manager or procurement lead signs when corporate authorization is required. They confirm coverage scope, billing routing, and any internal delegation rules; their signature establishes organizational intent to appoint the broker and triggers carrier processing.

Broker / Agent

A broker uses the BOR to document agency authorization and to request carrier acceptance. Brokers often attach appointment letters or agency licenses and must ensure the BOR matches carrier intake requirements to avoid processing delays.

Essential information to include on the Broker of Record

Policy Number: Primary insurer policy ID

Insured Name: Legal entity or individual

Broker Name: Full agency or broker name

Effective Date: MM/DD/YYYY effective date

Carrier Name: Insurer company name

Signature Date: Date signed by authorized signer

Common preparation mistakes to avoid

Using an informal email instead of a signed BOR; carriers often require a signed document for intake, which delays processing.
Mismatched insured or policy numbers between the BOR and carrier records; small discrepancies can cause rejection or manual review.
Failing to confirm carrier-specific acceptance rules; some insurers require their own BOR form or additional attachments to accept the appointment.
Missing authority documentation for organizational signers; carriers may request corporate resolution, power of attorney, or delegated signing authority.

Step-by-step: completing a Broker of Record

Complete the BOR by collecting policy data, confirming signer authority, and delivering the signed form to the insurer per carrier procedures.

01

Collect Data: Enter policy, insured, and carrier details accurately.
02

Confirm Authority: Verify signer is authorized by the insured or board.
03

Sign and Date: Obtain all required signatures and dates.
04

Submit to Carrier: Send per carrier instructions and retain proof.

How submission and carrier processing typically flow

Submitting a BOR usually triggers carrier validation, broker linking, and an acknowledgment. Workflow timing varies by insurer and delivery method.

Submit BOR: Deliver signed BOR to carrier or agent of record.
Carrier Validation: Carrier verifies policy and signer authority.
Broker Linking: Carrier updates account to reflect broker appointment.
Acknowledgment: Carrier may issue written acceptance or confirmation.

Digital submission, formats, and integration considerations

Choose delivery format and platform based on carrier preferences and required evidence of receipt.

File Formats: PDF, DOCX accepted
Integrations: CRM and document storage
Audit Trail: Timestamps and signer identity

Typical timelines and carrier processing expectations

Processing timelines vary by carrier and submission method; plan for verification and broker linkage steps when scheduling renewals or endorsements.

Carrier Acknowledgment:

Usually 1–10 business days upon receipt.

Policy Changes Effective:

Effective dates depend on carrier acceptance and policy terms.

Renewal Coordination:

Provide BOR before renewal notice to ensure broker access.

Dispute Resolution:

Allow additional time when coverage or billing conflicts occur.

Record Retention:

Keep submission proof until carrier confirms processing.

Key milestones from preparation to carrier acknowledgment

A sequential view of the main stages helps track progress and responsibilities during the broker appointment process.

01

Prepare BOR

Assemble policy data, signer authority, and supporting documents.

02

Sign and Authenticate

Obtain required signatures, notarization, or witness statements.

03

Submit to Carrier

Send by carrier-preferred channel with attachments and proof.

04

Carrier Response

Receive acknowledgment and verify broker linkage in account.

Core components to include in a professional Broker of Record

A complete BOR contains clear identification, explicit appointment language, signature authority, and any carrier-specific attachments required for acceptance.

Appointment Text

A concise statement naming the broker, the scope of authority (e.g., renewals, endorsements, claims), and an explicit declaration that the broker is authorized to act on the insured's behalf with the named carrier(s).

Insured Details

Full legal name, mailing address, and primary contact information for the insured. This section should match the carrier's policy records to avoid mismatches or rejected submissions.

Policy Identifiers

Complete policy number(s), line(s) of business, and any certificate or group identifiers. Accurate identifiers let carriers locate the correct account quickly and reduce manual intervention.

Effective Date

A clearly stated effective date for the broker appointment using MM/DD/YYYY format. The date determines when the broker's authority begins for renewals or endorsements.

Signature Block

Authorized signer name, title, signature, and date. Include witness and notary lines if the carrier or state requirements specify additional authentication.

Attachments

Supporting items such as agency license, corporate resolution, prior broker termination, and carrier-specific BOR forms required for acceptance and proof of authority.

Consequences of incomplete or incorrect Broker of Record forms

Claim Delays: Potential processing delays

Coverage Gaps: Risk of missed renewals

Rejection: Carrier may refuse appointment

Billing Errors: Premium routing mistakes

Legal Disputes: Authority or representation conflicts

Data Exposure: Improper sharing of policy details

Real-world examples of Broker of Record usage

Organizations often use BORs to improve response times, centralize broker management, and provide carriers with clear authorization to work with a named broker.

Martin Properties

A midsize property management firm centralized broker access to handle multiple landlord policies.

The BOR reduced duplicate carrier calls and consolidated renewal routing.
The founder reported that centralized appointments allowed quicker premium notices, fewer billing errors, and clearer documentation for audits and property managers.

Fertility Centers of Illinois

A healthcare provider appointed a broker to manage professional liability and benefits renewals.

The BOR streamlined insurer communications and reduced administrative burden.
The director noted the ability to exchange policy details securely and the value of documented broker authority during multi-carrier negotiations.

Comparing eSignature vendor pricing and capabilities for BOR workflows

Electronic signature platforms differ by price model, regulatory support, and feature set; below is a concise comparison with signNow first for reference.

	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 (Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA)	Yes	Yes	No	No

Answers to common Broker of Record questions

Frequently asked questions about validity, signing, carrier acceptance, and electronic submission are addressed below with practical guidance.

Need help? Contact support

Can a BOR be signed electronically?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the parties demonstrate intent, consent, attribution, and record retention capability.
Do carriers require notarization?
Most carriers do not universally require notarization for a BOR, but individual insurers or state rules may request notarized signatures or witness lines; confirm carrier-specific requirements before submission.
What if the carrier rejects the BOR?
If rejected, carriers typically provide a reason; correct errors, supply requested proof of authority, and resubmit. Retain rejection notices and correspondence for audit trails.
Who must sign for a corporation?
An authorized corporate officer or individual with delegated authority should sign. Carriers may request a corporate resolution or power of attorney to verify signing authority.
How should I submit supporting documents?
Attach agency license, prior broker termination, or resolutions as required. Use PDF attachments with clear filenames and maintain an audit trail of submissions and acknowledgments.
Can I revoke a BOR?
Yes. A revocation or replacement BOR should be signed by the insured and submitted to carriers; processing timelines vary and carriers may require additional documentation to accept revocation.

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