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					                                       Letterhead of Insured




Re: Insured’s Letter Requesting “COMPANY” to Change Producer of Record

Date:

INSURANCE
COMPANY

To Whom It May Concern:

I/we ask that you recognize Telcom Insurance Services Corporation as Agent of Record on the
following policies:

          Policy Number                             Expiration Date
        _________________                          _______________


The change is effective at the expiration date of the policy/policies listed above.

I understand that the intent of this letter is to notify COMPANY that the
______________________ Agency will no longer service the insurance policy/policies listed
above.

Sincerely,

_________________________
Signature

_________________________
Title

				
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posted:11/19/2011
language:English
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