Can a BOR be signed electronically?

Yes. Electronic signatures meet legal tests if intent, consent, attribution, and accurate retention are present (see ESIGN Act 15 U.S.C. ch. 96 and UETA). Confirm insurer accepts e-signed BORs and follow any carrier-specific submission instructions.

Does a BOR change commissions immediately?

Not necessarily. Commission transitions depend on carrier policies and any pre-existing agreements. Include commission or compensation language if the parties require immediate clarity to avoid disputes.

What if insurer rejects the BOR?

Insurer rejection commonly occurs for mismatched policy numbers, missing signatory authority, or improper delivery. Correct the specific issue and resubmit with proof of authorized signature.

Who can sign for a business?

A person with authority to bind the business (officer, owner, or delegated signatory) must sign and show title. For ambiguous authority, insurers may request corporate resolution or power of attorney.

Is notarization required?

Most BOR forms do not universally require notarization, but some insurers or specific states may request notarized signatures; verify carrier and local law requirements before submitting.

How long until the broker change is effective?

Effectiveness depends on the BOR effective date, insurer processing time, and carrier rules. Ask the insurer for an estimated processing timeframe and retain proof of submission.

Electronic Signature
Templates
Insurance
Insurance Broker of Record Form

Insurance Broker of Record Form

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

Insurance Broker of Record Form

Client Name: Policy Number: Current Insurer:

Applicant / Insured Information

Full Legal Name Doing Business As (DBA) / Trade Name (if any) Mailing Address

Phone

Email

Date of Birth / Organization Date

Current Policy Details

Policy Type / Line of Business

Coverage Limit

Deductible

Premium

Policy Period: From to Effective Date of Broker Appointment:

Broker to be Appointed

Broker Name Broker Agency / Firm

Broker License Number

Broker Phone

Broker Email

Broker Mailing Address

Scope of Appointment (select all that apply)

Lines / Coverages Property General Liability Automobile / Commercial Auto Workers' Compensation Professional Liability / Errors & Omissions Cyber Liability Umbrella / Excess Other:

Exclusions or Limitations to Scope (if any)

Beneficiary / Additional Contact

Primary Beneficiary / Contact Name

Relationship

Percentage

Additional Beneficiaries or Notes

Authorization and Certification

By signing below, the undersigned insured authorizes the insurer named above to appoint the broker identified in this form as Broker of Record with respect to the policy(ies) and coverages specified herein. This authorization permits the broker to receive policy information, bind or negotiate endorsements, receive premium and policy documentation, and act as the insured's representative solely to the extent specified in the Scope of Appointment.

The insured represents that it has full authority to appoint the broker for the policy(ies) listed and agrees that the appointment shall remain in effect until the insurer receives a written revocation or substitution signed by the insured. The insured acknowledges that this Broker of Record Form does not amend the terms of any policy and that all policy changes are subject to insurer approval and underwriting.

The insured authorizes the release of claim, underwriting and policy information to the appointed broker for the purpose of servicing the account. The insured agrees to indemnify and hold harmless the insurer and broker for actions taken in good faith under this appointment. This authorization is subject to applicable law and regulatory requirements.

Consent (check to confirm) I authorize release of policy and claim information to the named broker and consent to this Broker of Record appointment. I authorize the named broker to negotiate endorsements and refunds on my behalf where permitted by insurer and law.

Signature and Certification

I certify under penalty of perjury that I am authorized to execute this Broker of Record Form on behalf of the insured named above and that the information provided is true and correct to the best of my knowledge.

Applicant Name:

Signature:

Date:

What the Insurance Broker of Record Form Is and How It Works

An Insurance Broker of Record (BOR) Form is a written authorization that designates a specific broker or agency to represent a policyholder with an insurer for one or more insurance policies. It documents the policyholder's intent to transfer broker representation, enables the insurer to communicate with the newly appointed broker, and typically includes policy identifiers, effective date, and signature. Insurers use a BOR to update internal records, route notices, and permit the new broker to receive policy documents, quotes, and commissions on behalf of the insured.

Why a Clear Broker of Record Authorization Matters

A precise BOR Form prevents miscommunication between insurers and brokers, ensures correct routing of policy notices and renewals, and protects the insured’s ability to designate who can negotiate or receive confidential policy information.

Who Typically Uses a Broker of Record Form

Organizations and individuals use BOR forms whenever they change insurance representation or consolidate policies under a new advisor.

Commercial insureds switching brokers during renewal or after a claim
Individual policyholders consolidating personal lines under one broker
Human resources or risk managers appointing brokers for employee benefit programs

Use the BOR Form to create a clear, auditable record authorizing a broker to act on an insured’s behalf with a named insurer.

Essential Components a Professional BOR Form Should Include

A professional Broker of Record Form combines identifying data, explicit authorization language, and clear effective-date mechanics so insurers and brokers can act without delay or dispute.

Policy Identification

List each policy number, line of business, and insurer name so records match exactly and the insurer can locate affected contracts.

Broker Details

Include new broker name, agency, license number, mailing address, phone, email, and producer number for commission and contact routing.

Authorization Clause

A concise sentence naming the new broker as the authorized representative to receive policy information and negotiate on the insured’s behalf.

Effective Date

A clear MM/DD/YYYY effective date for the appointment and instructions for retroactive versus prospective appointments where applicable.

Compensation/Commission Note

Optional statement addressing broker commissions or a reference to existing brokerage agreement to avoid payment disputes.

Signature and Authority

Signature line, printed name, title, and date for the insured or an authorized signatory with capacity to bind the entity.

Step-by-Step: How to Complete and Submit a BOR Form

Follow these sequential steps from preparation through submission to avoid delays when changing broker representation.

01

Gather Policy Details: Collect insurer name and policy numbers.
02

Fill Broker Information: Enter new and current broker details accurately.
03

Sign and Date: Authorized signatory signs using MM/DD/YYYY.
04

Send to Insurer: Deliver per insurer instructions and retain proof.

Configuring an Online BOR Workflow

Set up digital fields and routing to mirror the paper process and capture an audit trail for compliance and recordkeeping.

Field	Configuration
Authentication	Email or SMS code; use stronger auth for large accounts
Routing Order	Insured signs first, then broker acknowledgment
Document Attachments	Attach prior policies or proof of commission agreements
Retention	Store signed BOR plus audit trail per retention policy

How Insurers Process a Broker of Record Form

Understanding insurer processing helps you set expectations for updates to policyholder records and communications routing.

Receive Authorization: Insurer logs BOR and verifies signatory authority.
Verify Broker: Insurer confirms broker license and producer number.
Update Records: System flags new broker and routes documents accordingly.
Notify Parties: Insurer notifies old and new brokers of the change.

Formats, Integrations, and Technical Considerations

Use platforms that support standard document formats, audit trails, and secure signer authentication to maintain legal validity.

File Formats: PDF, DOCX accepted by most insurers
Integrations: Salesforce, NetSuite, Google Workspace integrations available
Authentication: Email, SMS, or stronger multi-factor methods

Confirm insurer-specific submission requirements (email, portal upload, or mail) and keep a complete signed copy with audit data.

Security and Compliance Checklist for BOR Forms

Encryption: TLS 1.2/1.3 in transit, AES-256 at rest

Audit Trail: Timestamp, IP, and action log retained

Certifications: SOC 2 Type II, ISO 27001

HIPAA: BAA required for PHI-bearing records

ESIGN / UETA: Compliant with federal and state rules

Access Controls: Role-based permissions and SSO

eSignature Options for Completing the BOR Form (select capability comparison)

Comparison of typical vendor starting prices and a few capability dimensions relevant when eSigning Broker of Record forms; signNow is listed first per vendor rules.

	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 (Business Premium)	Varies by plan	Varies by plan	Yes	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Common Errors That Delay or Void Broker of Record Requests

Entering an incorrect policy number or insurer name that prevents matching to the insured’s account and causes rejection.
Omitting the effective date or using an ambiguous date, which leaves the insurer unable to determine when representation changes take effect.
Failing to include the authorized signatory’s title or capacity, which leads insurers to question whether the signer can bind the entity.
Not confirming insurer-specific submission methods (portal, email, or mail), resulting in missed updates or duplicate records.

Risks and Potential Consequences of an Incorrect BOR Form

Policy Misrouting: Loss of notices or renewal communications

Coverage Gaps: Unintended lapses from missed renewals

Commission Dispute: Disagreement between brokers and carriers

Claim Delays: Slower claim handling due to authorization issues

Regulatory Exposure: Potential licensing or disclosure questions

Rejection: Carrier refuses BOR for procedural errors

Typical Signatories and Their Authority

Corporate Officer

An officer who signs must include title and have explicit corporate authority; insurers commonly require officer-level signatory for commercial accounts.

Individual Policyholder

For personal lines, the named insured must sign; if an agent signs on behalf of the insured, a signed authorization or power of attorney may be required.

Use Cases: When Organizations Submit a BOR Form

Practical examples show why clarity and correct routing matter when assigning broker representation.

Optica Ventures (Commercial Renewal)

A growing real estate investor consolidated multiple property policies under one broker to streamline renewals

Broker verified producer numbers to avoid overlap
The insurer updated contact routing and the investor retained renewal notices centrally to prevent coverage gaps.

Fertility Centers of Illinois (Healthcare Program)

A healthcare provider changed brokers for employee benefits and required HIPAA‑aware handling of plan documents

New broker signed a BAA before receiving PHI-bearing materials
Processing included secure portals and retained audit trails to comply with HIPAA retention rules.

Frequently Asked Questions About Broker of Record Forms

Answers to common questions about execution, electronic submission, and legal effect of Broker of Record authorizations.

Need help? Contact support

Can a BOR be signed electronically?
Yes. Electronic signatures meet legal tests if intent, consent, attribution, and accurate retention are present (see ESIGN Act 15 U.S.C. ch. 96 and UETA). Confirm insurer accepts e-signed BORs and follow any carrier-specific submission instructions.
Does a BOR change commissions immediately?
Not necessarily. Commission transitions depend on carrier policies and any pre-existing agreements. Include commission or compensation language if the parties require immediate clarity to avoid disputes.
What if insurer rejects the BOR?
Insurer rejection commonly occurs for mismatched policy numbers, missing signatory authority, or improper delivery. Correct the specific issue and resubmit with proof of authorized signature.
Who can sign for a business?
A person with authority to bind the business (officer, owner, or delegated signatory) must sign and show title. For ambiguous authority, insurers may request corporate resolution or power of attorney.
Is notarization required?
Most BOR forms do not universally require notarization, but some insurers or specific states may request notarized signatures; verify carrier and local law requirements before submitting.
How long until the broker change is effective?
Effectiveness depends on the BOR effective date, insurer processing time, and carrier rules. Ask the insurer for an estimated processing timeframe and retain proof of submission.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now