Change of Broker

To drive Taxi and FHV (for-hire vehicle) in NY City TLC insurance is mandatory. TLC-licensed vehicles can only be insured by TLC authorized Provider (Broker/Agents). If driver wants can change Broker.

Program Overview

To drive Taxi and FHV (for-hire vehicle) in NY City TLC insurance (commercial auto insurance) is mandatory. TLC-licensed vehicles can only be insured by TLC authorized Provider (Broker/Agents). When driver wants they can change Broker. Change of Broker /Broker Change/Broker Record Change is a same phenomena.

Please fill up and submit the following form, and we’ll give you a call back as soon as possible. Or contact us through phone or email to provide necessary details to get started with the quote.

Broker Record Statement Record

Producer

Insurance Company

Code

Policy Number

Insured

MED/Plate#

EFF. Date

EXP. Date

STATEMENT INSURED

Your Name

Producer of record

Effective as of Date

Your Email

Contact Number

Insured's Signature

Drag and Drop (or) Choose Files

Today Date

Producer's Signature

Drag and Drop (or) Choose Files

Today Date

Phone

Tell: (646)-496-3480
Cell: (646)-496-3480
Fax:

Operating Hours

Open: 7 Days

Office Hours : 10:00 AM - 8:00 PM

Insurance Service Registration Form

CLIENT INFORMATION

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Your Name

Address

Phone

Email Address

Service/Program

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