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Louisiana Real Estate Commission
Post Office Box 14785
Baton Rouge, LA 70898-4785
1-800-821-4529 (in state only) or (225) 925-1923
APPLICATION TO TRANSFER LICENSE TO NEW BROKER
Remit transfer fee………………………...……………………………………………………………………….. $35.00
Fees should be made payable to the Louisiana Real Estate Commission in the form of a personal or company
Check, cashier’s check or money order. If you elect to participate in the Louisiana Real Estate Commission
Group Errors and Omissions policy, you must add the appropriate Errors and Omissions insurance premium as
Indicated in the premium schedule contained herein.
PART I
(Must be completed by the licensee requesting the transfer)
Name: ____________________________________________ License # ______________________________
(from wallet card, NOT SS#)
Telephone Number: __________________________________
Mailing Address: ____________________________________________________________________________
(Street/P.O. Box)
(City)
(State)
(Zip)
Check ( √ ) the applicable Errors and Omission Insurance coverage.
⌂
I am presently covered by the Louisiana Real Estate Commission group policy.
⌂
I elect to participate in the Louisiana Real Estate Commission group policy. I have attached the
appropriate premium as indicated in the premium schedule contained herein.
⌂
I elect to provide independent errors and omissions insurance coverage which complies with the
minimum requirements established by the Louisiana Real Estate Commission group policy:
____________________________________________________________________________________________________________________
(Provider)
(Policy Number)
(Expiration Date)
Signature of Licensee: __________________________________________ Date: ______________________
PART II
SPONSORING BROKER (This section must be completed by the new sponsoring broker/Corp.,LLC,Partnership)
–
Name:____________________________________________ License #: __________________________________
(Individual Broker or Corp., LLC, Partnership)
(Individual Broker or Corp., LLC, Partnership #)
Branch Office license number of office to which licensee will be assigned, if applicable: __________________
I agree to accept sponsorship of the licensee requesting this transfer.
Signature of Broker: ____________________________________________ Date: _______________________
PRO-RATED ERRORS AND OMISSIONS PREMIUMS
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
07
07
08
08
08
08
08
08
08
08
08
08
08
08
$36
$18
$184
$169
$153
$138
$123
$107
$92
$77
$61
$46
$31
$15
TransferNB Rev.3 11/07 (pending)
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