Free Agent/Broker Disclosure Generator
Create an insurance agent or broker disclosure covering role, licensing, market scope, compensation and conflicts. Edit model wording; export Word, HTML or PDF.
How to create your agent/broker disclosure
Gather actual licence details, jurisdictions, represented parties, insurer access, compensation sources, any customer fees, conflicts and complaint routes.
- 01
Confirm the actual scope
Identify the responsible organisation, audience and contact routes. USA is an editable sample country; applicable requirements also depend on the activity, state, product and people involved.
- 02
Tailor the example wording
Open each section, edit suitable model clauses and supply the actual facts. Restore example resets only that field. Applicable sample prices use USD ($). Closing a section brings the next section into view while preserving your answers.
- 03
Review and export
Read the complete preview, check relevant choices and remove any inaccurate commitment. Copy with formatting, download HTML or Word, or open Print / Save PDF. Each output contains a link to this exact generator.
- 04
Deliver and maintain the document
Place the notice or disclosure where customers receive it before the relevant decision, and follow any required delivery or acknowledgement process. Check separate prescribed forms and update material changes.
What your document covers
Producer and licences → role and market scope → compensation and fees → conflicts, information requests and acknowledgement.
Conditional questions follow the selected activity. Model procedures remain editable. Supply actual licence, authority, sharing and compensation facts relevant to this document.
Scope, privacy and review
Producer disclosure requirements vary by state, product and transaction. Verify licence/appointment status and compensation rules. This tool does not confer authority or satisfy every annuity, replacement or best-interest disclosure.
- Generation happens in this browser. Answers are not sent to a document-generation service or saved between visits; download before leaving.
- Enter business-level practices, not customer financial, health or identifying records. Complete any private acknowledgement through your approved process.
- Review actual facts, authority and applicable requirements. Generation does not bind insurance, verify licences or certify compliance.
Substantive update: 9 October 2026. No review by a named legal professional or legal certification is claimed.
Frequently asked questions
Is this free, and do I need an account?
The generator, formatted copy and HTML or Word downloads are free and require no account. PDF uses the browser’s Print / Save PDF dialog.
Does disclosure authorise a broker fee automatically?
No. Disclose the actual fee and services, check local restrictions and obtain any separate written agreement or consent required before charging. An acknowledgement of receipt is not automatically a fee agreement or waiver of rights.
Can I keep or edit the pre-filled examples?
Yes. Fields marked Editable example contain model wording with Restore example controls. USA is an editable sample country, and applicable sample prices use USD ($). Keep wording only if it accurately describes your arrangements. Actual identities, licence details, risks and data practices need your input.
Does this document bind insurance or verify a licence?
No. Use the appropriate insurer approval and binding process, verify current licensing independently and deliver any separately required statutory form. Generation does not bind coverage or certify compliance.
Reference for your review
New York DFS: producer role and compensation disclosures. Check the rules and prescribed notices applicable to your institution, jurisdiction and activity.