Authorization letter designating a new insurance broker or agent as the insured's broker of record for specified policies, revoking prior broker authority and directing all insurers and markets to recognize the incoming broker.
The Broker of Record (BOR) Letter is a ready-to-use insurance & risk template you can send for signature in minutes. It is written for 1 signer (insured) and, by default, expires 14 days after it is sent if left unsigned. It covers broker of record, bor letter, insurance broker, agent of record, broker change, insurance authorization. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Broker of Record (BOR) Letter **Letter Date:** ___________ --- ## 1. Named Insured Information **Named Insured (exactly as it appears on all affected policies):** ___________ **Named Insured Mailing Address:** ___________ **Named Insured Contact Name:** ___________ **Named Insured Contact Email:** ___________ **Named Insured Contact Phone:** ___________ --- ## 2. Incoming Broker (New Broker of Record) **Agency / Brokerage Name:** ___________ **Agency Address:** ___________ **Agent / Broker Name:** ___________ **Agent / Broker License Number:** ___________ **Agent / Broker Email:** ___________ **Agent / Broker Phone:** ___________ --- ## 3. Prior Broker (Outgoing Broker, if known) **Prior Agency / Brokerage Name:** ___________