Appointment of Financial Professional (Broker of Record) Form Preview on Page 1

Appointment of Financial Professional (Broker of Record) Form 2026

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  1. Click ‘Get Form’ to open the Appointment of Financial Professional (Broker of Record) Form in our editor.
  2. Begin by filling out the Participant Information section. Enter your first name, last name, social security number, phone number, and email address accurately.
  3. Next, provide the Investment Firm/Agency Information. Include the firm’s name, street address (no P.O. boxes), city, state, ZIP code, phone number, fax number, website, and RIA Firm Number if applicable.
  4. Indicate whether the Investment Firm/Agency has completed the Investment Firm Set-Up Form & Agreement by selecting the appropriate option.
  5. Fill in details for both Primary Advisor and Secondary Contact sections including their names, phone numbers, emails, and IAR Rep IDs if applicable.
  6. Specify the annual basis point advisory fee that will apply to your account in the Investment Firm/Agency Fee section.
  7. Review the Participant Authorization section carefully before signing. Ensure you understand what access you are granting to your Financial Professionals.
  8. Finally, sign and date the form at the bottom to complete your submission.

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Fla. Admin. Code Ann. R. 69B-211.002 - General Procedures

An entity wishing to appoint an insurance representative to transact insurance on behalf of that entity shall complete and submit Form DFS-H2-501, Appointment

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