Designation db representatives 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the date at the top of the form. This is essential for record-keeping.
3. In section (A), provide the names and signatures of your designated representatives along with their addresses and telephone numbers. Ensure that all information is accurate and up-to-date.
4. Repeat this process for sections (B) and (C), which require similar details for additional representatives related to acceptance of insurance contracts and claims.
5. At the bottom, include the name of your insurance carrier, home office address, date, and authorized signatory's title and contact number.
6. If applicable, attach a list of district or regional claims offices as instructed, ensuring all required details are included.

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