Asi Form 6609-06 - Sponsoring Broker Change/transfer Request printable pdf download

DISTRICT OF COLUMBIA

REAL ESTATE BOARD

SPONSORING BROKER CHANGE/TRANSFER REQUEST

(ASI Form 6609-06)

GENERAL INSTRUCTIONS:

All applicants must complete every section of this application and submit the original application with the total fee due.

False or misleading statements will be cause for disciplinary action and could be cause for criminal prosecution pursuant to D.C. Code 22-2514. If more space is

needed to fully answer questions, attach additional sheets. If you have any questions, call ASI Customer Service at 888-204-6192.

TYPE OF APPLICATION AND FEES

--This form will be returned unprocessed if the fee is not included or if the fee is less than required. Make

check or money order payable to: Assessment Systems Inc. CASH PAYMENTS WILL NOT BE ACCEPTED.

Sponsoring Broker Transfer

Change License Designation (Identify NEW designation in Section 4)

Make fee payable to Assessment Systems Inc.

A charge of $50.00 will be imposed for dishonored checks

Change/Transfer fee

$20.00

(Public Law 89-208)

2A. NAME OF LICENSEE

FIRST NAME

LAST NAME

TRADE NAME (Optional--to be approved for Independent Brokers and Independent Property Managers ONLY)

2B. Social Security Number*

2C. License Number with Prefix

(SP, IB, AB, PB, or PM)

PREVIOUS SPONSORING BROKER’ S RELEASE--

If changing sponsoring brokers, this section is to be completed by the broker who is

releasing the employment of the Salesperson, Principal Broker, Associate Broker or Property Manager license.

_______________________________________________________________________

COMPANY NAME

________________________________

COMPANY LICENSE NUMBER

COMPANY FEIN

________________________________________________

_____________________________________

PRINCIPAL BROKER SIGNATURE

DATE

4. NEW SPONSORING BROKER’ S STATEMENT

– ALL APPLICANTS should have this section completed by their sponsoring broker, making

sure that the new license designation is marked. Applicants applying to change their license designation to Independent Broker should only mark the

designation and sign the form.

LICENSEE’ S DESIGNATION:

______________________________________________________

Salesperson

Principal Broker

Associate Broker

Independent Broker

COMPANY NAME

Property Manager

____________________________________________________________

COMPANY LICENSE NUMBER

____________________________________________________________

COMPANY FEIN

I have read this application in full. In my opinion, ________________________________________________, the applicant, is honest, truthful, and of

good reputation, and I recommend that the license be granted.

_________________________________________________________

_________________________________________________

PRINCIPAL BROKER/INDEPENDENT BROKER SIGNATURE

DATE

Mail form and fee to:

ASI/DC Real Estate Board

PO Box 13805

Philadelphia, PA 19101-3805

1-888-204-6192

*Under the authority of Public Law 93-579, Section 7 (b), the Department of Consumer and Regulatory Affairs requests your Social Security Number to assist in

the administration of D.C. tax law. Disclosure is not required as a part of the licensing process and will not be made available to the public.

ASI#6609-06 ISBN#999-850-7561