Allianz Change Of Agent Form Details

Are you looking for a new insurance provider? If so, Form Allianz may be the perfect option for you. We offer a wide range of coverage options, so you can find the protection that's right for your needs. Plus, our team is committed to providing outstanding customer service. We'll work with you to find the best policy at a price that fits your budget. Contact us today to learn more about our products and services.

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QuestionAnswer
Form NameForm Allianz
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesallianz life forms, allianz forms, allianzlife com forms, allianz forms download

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Representative/Agent Change

Complete form and mail to address located on the bottom of this form.

Representative must be appointed with Allianz Life Insurance Company of North America. For Licensing, call 800.226.0574.

If not appointed, complete the Representative Appointment Request Form.

Representative’s name (print)

Name of broker/dealer

Representative’s business address

Street, City, State, ZIP code

(

)

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)

 

 

Business telephone number

Business fax number

Individual changes

Contract owner name

Contract number

I (we) the contract owner(s), want my (our) new representative to have telephone transfer access to my contract. Contract owner’s initials: ________

Block changes

This is a block/bulk change — attach list of contract owners’ names

This is a block/bulk transfer — attach list of contract numbers

Signatures

Individual changes

Contract owner’s signature

Date

OR

Previous branch manager’s signature

Block changes

Date

 

 

 

Accepting branch manager’s signature

Date

FAX TO: 610.251.2337 MAIL TO: Allianz Life - Allianz Service Center, PO Box 1122, Southeastern, PA 19398-1122

QUESTIONS: Call the Allianz Service Center at 800.624.0197, Monday-Friday between 8:00 a.m. and 7:00 p.m. Eastern time

USA-374

(R-5/2006)

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