must be submitted on company letterhead - Cornerstone Insurance ...

MUST BE SUBMITTED ON COMPANY LETTERHEAD
(Date)
Sales Compensation – Central Region
Anthem Blue Cross Blue Shield
4241 Irwin Simpson Road
Mason, OH 45040
Re: (Group Name) – (Group Policy #)
To Whom It May Concern:
(Broker Name – Sub-Agent Code) is authorized as our new writing agent for our group
<strong>be</strong>nefits provided by your company. Cornerstone Broker Insurance Service Agency, Inc. (CRN)
is authorized as our Elite Plus Broker. This designation supersedes any other designation. We
understand that any compensation will <strong>be</strong> paid to our new agent.
Sincerely,
(Authorized Representative)

MUST BE WRITTEN BY CLIENT
FORM LETTERS ARE NOT ACCEPTED FOR
INDIVIDUAL POLICIES
(Date)
Anthem Blue Cross Blue Shield
4241 Irwin Simpson Road
Mason, OH 45040
Re: (Individual’s Name) – (Policy #)
To Whom It May Concern:
(Broker Name - SSN) of (Agency Name – Tax ID) is authorized as my new writing agent for
my individual <strong>be</strong>nefits provided by your company. CBISA Reacquisition Corporation (31-
1768631) is authorized as the Elite Plus Broker. This designation supersedes any other
designation. I understand that any compensation will <strong>be</strong> paid to my new agent.
Sincerely,
(Policy Holder)