Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

Company Logo

DATE

BROKER OF RECORD LETTER

To: ALL HMO PROVIDERS

We hereby authorize PASCUAL BROKERS CO. as our duly appointed exclusive


intermediary/ broker to negotiate on our behalf pertaining to health plan requirements.

May request you to furnish the abovementioned all pertinent information required, in
connection with this service.

We appreciate your prompt attention on this matter.

This supersedes all previous communications and instructions. The authority herein shall
remain in full force until cancelled in writing within 365 days notice.

Thank you!

Respectfully Yours,

AUTHORIZED SIGNATORY
(Signature over printed name/ Position)

Date Signed

You might also like