For Producers

Compensation disclosure form

Our optional compensation disclosure form (PDF, 97KB) can help you keep compliant records. If you decide to use our form, remember:

If the only compensation you receive is a commission from an insurer

There is no need to complete a compensation disclosure form.

If the only compensation you receive is from the fee being charged (you do not receive any commission) 

Complete Part 1 of the form.

If you charge a fee and receive a commission from an insurer 

Complete Part 2 of the form.

If you charge a fee, receive an initial commission and could possibly receive contingent commissions in the form of awards, bonuses, etc. 

Complete Parts 2 and 3 of the form.

Always make sure both the writing producer and the insured/client sign and date the form. The completed form should be retained by the writing producer for five years.