Transfer Of Real Estate Broker Or Salesperson License Form - State Of Rhode Island And Providence Plantations Department Of Business Regulation
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1State of Rhode Island and Providence Plantations
DEPARTMENT OF BUSINESS REGULATION
1511 Pontiac Avenue, Bldg. 69-1
Cranston, Rhode Island 02920
Division of Commercial Licensing
Real Estate Section
TRANSFER OF REAL ESTATE BROKER OR SALESPERSON LICENSE
Please submit the following with this completed form. All incomplete submissions will be returned.
● A Certificate of Errors and Omissions Insurance.
● A check or money order for $25 made payable to the Rhode Island General Treasurer.
I, ___________________________________________, ______________________, of
(Name)
(License Number)
____________________________________________, ____________________________, __________________,
(Home Address)
(City)
(State)
_____________________, ___________________________________, __________________________________________________________,
(Zip Code)
(Phone Number)
(Email Address)
request the transfer of my license from ____________________________________________ to
(Current Agency Name)
_________________________________________________.
(New Agency Name)
__________________________________________________
_________________________________
(Signature of Salesperson or Broker)
(Date of Transfer)
STATEMENT OF NEW EMPLOYING BROKER
I, the undersigned, being a licensed real estate broker of the State of Rhode Island, certify that
___________________________________, will be associated with/ employed by this agency.
(Licensee’s Name - Print)
_____________________________________________, _______________________________________________,
(Agency Name)
(Agency Address)
______________________________, _______________, ____________________, _________________________.
(City)
(State)
(Zip Code)
(Phone Number)
I,
____________________ affirm that the statements
_______________________________________,
(Principal Broker – Print)
(License Number)
contained herewith are true.
______________________________________
(Signature of Principal Broker)
Tel: 401-462-9512
Fax: 401-462-9645
TTY: 711
Web Site:
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