ACORD 36: Agent/Broker of Record Change
ACORD 36 is the Agent/Broker of Record Change. It records the insured's instruction to appoint an agency for the policies identified on the form.
What it is
ACORD 36 is the Agent/Broker of Record Change. It records the insured's instruction to appoint an agency for the policies identified on the form.
Carrier acceptance, effective dates, servicing access, and commission arrangements require separate confirmation. The request should identify the correct policies and authorized signer so the carrier can evaluate and process it.
When it's used
- An insured wants a different agency to represent specified policies.
- A carrier accepts an ACORD 36 for its agent-of-record process.
- Your team needs to document which policies are included in a representation request.
Section-by-section walkthrough
Date and effective date
The signing date and the requested effective date for the representation change.
Review check: Separate the signing date, requested date, and accepted date.
Carrier and policy numbers
The carrier the notice is addressed to and the specific policy numbers moving.
Review check: List the specific policies included.
Named insured information
The policyholder's legal name and address as the carrier has them on file.
Review check: Match the carrier's insured record.
Appointment statement
The appointment wording and the agency the insured wants to appoint for the identified policies.
Review check: Read the appointment wording with the insured.
Insured's authorized signature
The signature of a person authorized to act for the insured, as required by the process.
Review check: Confirm the signer can act for the insured.
New agency information
The incoming agency's name, address, and identifying codes with the carrier.
Review check: Verify carrier appointment and processing requirements.
In Relay
Relay can prepare supported ACORD drafts from the documents you provide. This reference guide explains ACORD 36; it is not a promise that this form or edition is available in your workspace. Check the supported form, then review the fields and missing answers before use. See how →
Common errors
- Assuming commissions change immediately when the form is signed.
- Using vague policy identification.
- Treating submission as proof of carrier acceptance.
Common questions
Does ACORD 36 change the policy coverage?
Its purpose is representation, not a coverage endorsement. Any requested coverage change needs the appropriate separate process. Confirm the carrier's treatment of the representation request.
When do servicing and commissions move?
Confirm those details with the carrier. A signed request alone does not establish the effective date, appointment requirements, or commission outcome.
Form references
- ACORD Forms Portal: current forms and authorized access
- ACORD-authored Forms Index, May 2024 (historical form names)
Confirm the form edition and requirements with the market receiving the submission.
Part of the Relay ACORD form library. Updated 2026-07-11. See how we source content.
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