Agent/Broker of Record Appointment


(through Excess Markets (B.C.) Corporation)

Re: Insurance Policy # 


hereby confirm the appointment of Excess Markets (B.C.) Corporation in Richmond of B.C. as our Agent/Broker of Record effective from

This authorization of appointment supersedes all other appointments given or inferred and shall remain effective until cancelled in writing by either party named herein.

Excess Markets (B.C.) Corporation are hereby authorized to obtain all information, including copies of policies as may be deemed necessary by them to act in their capacity as our Agent/Broker.

It is expressly understood and agreed that Excess Markets (B.C.) Corporation assume no responsibility whatsoever for coverage currently in effect nor for outstanding premiums or commissions.