Broker of Record (BOR) Agreement

If you are unhappy with your current insurance agent or broker because they are not meeting your policy needs or service expectations? Please consider completing our Broker of Record Agreement. This agreement helps us to accomplish the following:

End the current relationship between you as the policy holder and your current broker or agent as your insurance representative for all carriers listed on the BOR.
Appoints the Life is Precious – Better Insure It licensed insurance professional you have been working with as your NEW broker for policies already in force.
Officially notifies your insurance carrier(s), of our new client/broker partnership.
Allows us to inquire on any unresolved existing claims, access to previous underwriting decisions, and obtain your Protected Health Information (PHI) should we need to appeal any decisions or inquire on your behalf in the future.
Provides a transition period between brokerages or agencies so that all parties can discuss the transfer, of any and all notes pertaining to your current policies to ensure a smooth transition for you, the policyholder and our new valued client.

Insured's Name(Required)

First Middle Initial Last

Insured's Email(Required)

Insured's Address

Street Address Address Line 2 City State ZIP Code

Insurance Company Name(Required)

Insurance Company's Address

Street Address Address Line 2 City State ZIP Code

How many Policies do you have with this Insurance Company?

Policy 1

Policy Name(Required)

Policy Number(Required)

Plan Effective Date(Required)

Policy 2

Policy Name

Policy Number

Plan Effective Date

Policy 3

Policy Name

Policy Number

Plan Effective Date

My Insurance Agent(Required)

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Broker of Record (BOR) Agreement

Policy 1

Policy 2

Policy 3

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