Release Request Form
This form is required and must be completed in full to begin the release process with Trusted Senior Specialists. (NO RELEASES GRANTED BETWEEN 8/1 AND 12/31)
Name of Agent Requesting the Release?
*
First Name
Last Name
What Carrier(s) are Being Requested?
*
Reason for Requesting a Release?
*
Release Policy: To be eligible for release the following requirements must be met: 1)Agent must have a $0 debit balance for all carriers being released. 2)Must have approval from any middle tier agent/agency if not direct to TSS. 3)Releases for past employees are considered on a case-by-case basis. Other factors may be considered and are subject to approval by a Principal of TSS. Please check "Yes, I understand" below to acknowledge your understanding and agreement with this process, then sign in the box below to begin the release process.
*
Yes, I understand.
Agency Partners: If you are completing the release request form on behalf of a downline agent/agency, please select which type of release you wish to provide.
Please Select
Reciprocal Release Agreement
Letter of Release
Please note that if you do not make a selection above, a standard Letter of Release will be provided so long as the agent has a $0 debit balance with all carriers.
Please upload a copy of the Reciprocal Release Agreement or Carrier Specific Release/Transfer Form (as applicable).
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Clear
Submit
Should be Empty: