Can I e-sign the BOR form?

Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the carrier accepts e-signatures and required disclosures are made. Confirm carrier policy on electronic submissions before relying on e-signatures.

Does the insured always need to sign?

Many carriers require the insured's explicit authorization to change broker of record; if the insured is a corporate entity, an authorized officer must sign. Carrier rules vary; check the carrier's BOR form or guidelines.

When is notarization required?

Notarization is not universally required for BOR forms but may be requested by some carriers or states. Verify state rules and carrier requirements; use RON if accepted by both parties and the carrier.

What happens if the carrier rejects the form?

Carriers typically issue a follow-up request citing missing or mismatched information. Provide the requested corrections promptly to avoid commission or servicing delays.

How should I store completed BOR forms?

Retain signed originals and digital audit trails for the policy lifecycle plus applicable retention periods; follow IRS, HIPAA, and state rules where relevant for document retention.

Who can revoke a BOR appointment?

Revocation procedures depend on policy language and carrier rules; typically the insured or an authorized representative can revoke by submitting a written notice to the carrier following the carrier's specified process.

Electronic Signature
Templates
Insurance
Insurance RPS BOR Form

Insurance RPS BOR Form

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

INSURANCE RPS BOR FORM

Applicant / Insured Information

Insured Name:

Mailing Address

Date of Birth:

Tax ID / SSN:

Contact Phone:

Entity Type

Individual Corporation LLC Partnership Other:

Policy Details — Apply BOR to the Following Policy(ies)

Primary Insurer:

Policy Number

Policy Type:

Coverage Amount:

Deductible:

Annual Premium:

Policy Period From:

To:

Additional Policies (list policy number, insurer, type)

Broker of Record Appointment

Current Broker of Record (if any):

New Broker to be Appointed:

New Broker Contact Information

Phone:

License No.:

Email:

Requested Effective Date of Appointment:

Coverage Selection

Select the policy lines to which this Broker of Record appointment applies:

General Liability Property Commercial Auto Workers' Compensation Professional Liability / E&O Other:

Exclusions and Limitations

The appointment of Broker of Record is subject to the terms of the underlying policy(ies) and does not alter coverage terms, limits, exclusions, premiums, or endorsements issued by the insurer. The insured acknowledges that the insurer retains sole authority to accept or reject any change in producer records pursuant to policy and regulatory requirements.

Specific Exclusions or Limitations (if any)

Beneficiary for Return Premiums / Notices

Beneficiary Name:

Relationship:

Percentage:

Declarations, Authorizations and Certifications

By signing this Insurance RPS BOR Form, the insured hereby appoints the New Broker named above as Broker of Record for the policy(ies) identified herein, authorizes the insurer and its representatives to disclose insurance policy information and claims data to the New Broker, and authorizes the New Broker to request policy changes and to receive notices and communications relevant to placement and servicing. This appointment supersedes any previously submitted Broker of Record appointment for the same policy(ies) to the extent permitted by applicable law and the insurer's procedures.

The insured further certifies that the information provided on this form is true and correct to the best of their knowledge. The insured acknowledges that appointment of Broker of Record does not guarantee binding of coverage or changes to policy terms, and that premium payments and notices remain the insured's responsibility until otherwise agreed in writing by the insurer and broker.

Insured Authorization

I authorize release of policy information and claims history to the New Broker named above. I authorize assignment of broker compensation to the New Broker, subject to insurer approval and existing agreements. I consent to electronic transmission of this appointment and acknowledge electronic signatures are admissible and binding for purposes of this appointment.

Acknowledgment

The insured understands that an insurer may require additional documentation before effecting the change of Broker of Record. The insured agrees to indemnify and hold harmless the insurer and its representatives from any liability arising from reliance on the information provided in this form, including but not limited to errors, omissions, or misrepresentations.

Additional Instructions or Comments

Signature of Insured

Print Name:

Signature:

Date:

By signing above, the insured certifies under penalty of perjury that the information provided is accurate and that they are authorized to make this appointment on behalf of the named insured.

What the Insurance RPS BOR Form Is and when it's used

The Insurance RPS BOR Form documents designation or transfer of broker-of-record authority and related policy servicing instructions between insurance producers and carriers. It is commonly used when a policyholder elects a new broker to manage renewals, commissions, or claims handling. The form typically identifies the policy, the parties, the effective date of appointment, and any limits or exclusions. Organizations use it to ensure carriers and administrators recognize the new broker relationship and to create an auditable record for commissions and servicing changes.

Why the Insurance RPS BOR Form matters for carriers and brokers

Using a clear, complete Insurance RPS BOR Form reduces disputes over commission allocation and avoids lapses in policy servicing. It creates a written authority trail carriers can rely on for processing broker appointments and protects all parties by documenting intent and scope.

Primary users and stakeholders for this form

The Insurance RPS BOR Form is completed and reviewed by several roles across insurance transactions.

Insurance producers and brokers — prepare and submit the BOR to establish representation and commission directions.
Policyholders (clients) — sign or authorize the broker appointment when required by carrier rules.
Carrier underwriting or servicing teams — accept and record the broker designation in policy systems.

Understanding who completes and who receives the form helps ensure correct routing and faster processing.

Simple step-by-step: filling and submitting the form

Complete the form in the order below to help carriers verify and process the BOR quickly.

01

Prepare documents: Collect policy declarations and broker license information.
02

Complete fields: Enter policy, insured, and broker details accurately.
03

Obtain signatures: Have the insured and broker sign using permitted methods.
04

Submit to carrier: Send the completed form to the carrier's servicing or brokerage department.

Typical processing flow for an Insurance RPS BOR Form

The following sequence outlines how carriers and brokers usually process a BOR form after receipt.

Receipt and intake: Carrier logs the form and assigns a tracking reference.
Verification: Carrier confirms policy number and broker license details.
Acceptance or follow-up: Carrier accepts appointment or requests clarifying information.
System update: Broker designation is entered into policy and commission systems.

Key workflow settings to configure for digital completion

Configure your electronic workflow to ensure validation, signer authentication, and archival meet carrier expectations.

Field	Configuration
Policy Number	Required; exact-match validation
Broker License	Required; formatted numeric field
Effective Date	Date picker; MM/DD/YYYY
Signature	eSignature field with audit trail

Technical considerations for e-submission and compatibility

Verify carrier acceptance of electronic submission and the authentication level required before sending.

Supported file formats: PDF, DOCX are commonly accepted by carriers.
Authentication: Email plus SMS or KBA when carriers require higher assurance.
Audit trail: Include timestamp, IP address, and signer evidence.

Retain signed copies and audit records to support commission and servicing disputes; confirm carrier-specific submission endpoints.

Essential sections every professional Insurance RPS BOR Form should include

A consistent structure helps carriers and brokers process appointments without delay. Ensure these six components are present and clear.

Identification

Policy and insured details that uniquely identify the policy being reassigned, avoiding ambiguity in carrier systems.

Broker details

Broker name, license number, address, and contact information for validation and commission routing.

Scope and exclusions

Clear statement of services the broker may perform and any transactions excluded from the appointment.

Effective date

When the appointment and related commission changes take effect for renewals and endorsements.

Signatures

Authorized signatures from the insured and broker, with printed names and dates for authentication.

Carrier acknowledgement

Optional carrier signature or acceptance section to record receipt and formal recognition of the appointment.

Data elements to protect and verify

Personally Identifiable Information: Protect insured names and DOB

Policy Identifiers: Encrypt policy numbers in transit

Broker Licensing: Validate license numbers securely

Signatures: Capture audit trail metadata

Contact Details: Store addresses and emails securely

Commission Instructions: Restrict access to financial directions

Common legal and financial risks of incomplete or incorrect forms

Commission disputes: Loss of expected commissions

Servicing gaps: Claims or renewal actions delayed

Regulatory noncompliance: State insurance regulator inquiries

Fraud allegations: Unauthorized broker claims

Contract ambiguity: Disagreements over scope

Data breaches: Exposure of PII

Frequent preparation errors to avoid

Entering an incorrect policy number breaks automated routing and requires manual reconciliation with carrier records, prolonging processing.
Using informal or inconsistent insured names (DBA vs legal entity) can prevent carriers from matching the form to the correct policy account.
Failing to include a broker license or providing an expired license number leads carriers to reject the appointment pending verification.
Submitting unsigned or partially signed forms is a leading cause of rejection; include all required signatures and dates before submission.

Typical timing expectations and carrier deadlines

Processing times and deadlines vary by carrier; plan submissions to account for verification and systems updates.

Submission lead time:

Submit at least 10–15 business days before renewal activity.

Carrier verification:

Carrier responses typically within 5–15 business days.

Effective date rules:

Effective date may be subject to policy terms and not retroactive.

Commission cutoffs:

Carrier commission cycles may require earlier processing.

Record retention:

Keep receipt and audit trail indefinitely or per carrier policy.

Comparison of common eSignature options for processing BOR forms

Choose a provider that meets carrier authentication and compliance needs. This table compares typical starting prices and core features.

	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	Yes, 7-day trial	No	No	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about the Insurance RPS BOR Form

Answers to common questions about completion, signature validity, and carrier acceptance for BOR forms.

Need help? Contact support

Can I e-sign the BOR form?
Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the carrier accepts e-signatures and required disclosures are made. Confirm carrier policy on electronic submissions before relying on e-signatures.
Does the insured always need to sign?
Many carriers require the insured's explicit authorization to change broker of record; if the insured is a corporate entity, an authorized officer must sign. Carrier rules vary; check the carrier's BOR form or guidelines.
When is notarization required?
Notarization is not universally required for BOR forms but may be requested by some carriers or states. Verify state rules and carrier requirements; use RON if accepted by both parties and the carrier.
What happens if the carrier rejects the form?
Carriers typically issue a follow-up request citing missing or mismatched information. Provide the requested corrections promptly to avoid commission or servicing delays.
How should I store completed BOR forms?
Retain signed originals and digital audit trails for the policy lifecycle plus applicable retention periods; follow IRS, HIPAA, and state rules where relevant for document retention.
Who can revoke a BOR appointment?
Revocation procedures depend on policy language and carrier rules; typically the insured or an authorized representative can revoke by submitting a written notice to the carrier following the carrier's specified process.

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