Form CSR-2 "Customer Service Representative Appointment Cancellation" - Oklahoma

What Is Form CSR-2?

This is a legal form that was released by the Oklahoma Insurance Department - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 24, 2011;
  • The latest edition provided by the Oklahoma Insurance Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CSR-2 by clicking the link below or browse more documents and templates provided by the Oklahoma Insurance Department.

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Download Form CSR-2 "Customer Service Representative Appointment Cancellation" - Oklahoma

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CSR-2
Revised 01242011
OKLAHOMA INSURANCE DEPARTMENT
th
3625 NW 56
, Suite 100
Oklahoma City, OK 73112-4511
(405) 521-3916 or Fax: (405) 522-3642 Toll Free In-State 800-522-0071
Customer Service Representative Appointment Cancellation
Please type or print clearly.
___________________________
Check here if Title coverage only
CSR LICENSE NUMBER
(Issued by Oklahoma Insurance Department)
CSR’s SS #: _______________________________
CSR’s Name:
(Last)
(First)
(MI)
Being duly licensed by the State of Oklahoma Insurance Department, I hereby affix
my name below in testimony that I will no longer supervise the work of the above
mentioned customer service representative, nor obligate myself to supervise the
customer service representative’s conduct of insurance-related business or review
such work of this customer service representative.
This Customer Service
Representative’s appointment is to be canceled effective ________________________.
(Date)
Dated this _________ of _______________________________ 20________
(Signature of Authorized Sponsoring Agent/Broker/Agency)
Print ___________________________________________________________________________
(Sponsoring Agent/Broker/Agency)
Title (Print)
Address:
Oklahoma License Number
City:
(
)
(
)
State:
Zip:
Business Phone:
Business Fax:
FOR INSURANCE DEPARTMENT USE ONLY
Processed by:
Date:
Print Form
CSR-2
Revised 01242011
OKLAHOMA INSURANCE DEPARTMENT
th
3625 NW 56
, Suite 100
Oklahoma City, OK 73112-4511
(405) 521-3916 or Fax: (405) 522-3642 Toll Free In-State 800-522-0071
Customer Service Representative Appointment Cancellation
Please type or print clearly.
___________________________
Check here if Title coverage only
CSR LICENSE NUMBER
(Issued by Oklahoma Insurance Department)
CSR’s SS #: _______________________________
CSR’s Name:
(Last)
(First)
(MI)
Being duly licensed by the State of Oklahoma Insurance Department, I hereby affix
my name below in testimony that I will no longer supervise the work of the above
mentioned customer service representative, nor obligate myself to supervise the
customer service representative’s conduct of insurance-related business or review
such work of this customer service representative.
This Customer Service
Representative’s appointment is to be canceled effective ________________________.
(Date)
Dated this _________ of _______________________________ 20________
(Signature of Authorized Sponsoring Agent/Broker/Agency)
Print ___________________________________________________________________________
(Sponsoring Agent/Broker/Agency)
Title (Print)
Address:
Oklahoma License Number
City:
(
)
(
)
State:
Zip:
Business Phone:
Business Fax:
FOR INSURANCE DEPARTMENT USE ONLY
Processed by:
Date: