Agent of Record Contract

By signing this form, I acknowledge S Philips Surety & Insurance Services Inc as my agent of record effective immediately. This appointment rescinds all other appointments and shall remain in full force until canceled by us in writing. We request this broker of record change to take effect immediately and we waive any applicable waiting period.

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Signed by Shay Philips
Signed On: April 29, 2022

Signature Certificate
Document name: Agent of Record Contract
lock iconUnique Document ID: 7186b338b29e239abb6f76610fc3e12425878f0a
Timestamp Audit
December 16, 2021 12:17 pm PSTAgent of Record Contract Uploaded by Shay Philips - IP