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Agent – Offboarding
This form should be filled out only by approved managers/owners
Please provide minimum of 3 business days
Requestor
Name
(Required)
First
Last
Email
(Required)
Terminated User
Name
(Required)
First
Last
Email
(Required)
Phone
Franchise
(Required)
--Please Select--
InsureLine Brokers Inc.
InsureLine Brokers (Advantage)
InsureLine Brokers (Alder)
InsureLine Brokers (Anchor)
InsureLine Brokers (Blue)
InsureLine Brokers (Cedar)
InsureLine Brokers (Clear Cut)
InsureLine Brokers (Clover)
InsureLine Brokers (Complete)
InsureLine Brokers (Connect)
InsureLine Brokers (Cornerstone)
InsureLine Brokers (Empire)
InsureLine Brokers (Enterprise)
InsureLine Brokers (Excel)
InsureLine Brokers (Hamptons)
InsureLine Brokers (I.D.)
InsureLine Brokers (Icon)
InsureLine Brokers (Imperial)
InsureLine Brokers (Infinity)
InsureLine Brokers (Island Living)
InsureLine Brokers (Lighthouse)
InsureLine Brokers (LNG)
InsureLine Brokers (Mutual Aid)
InsureLine Brokers (Pearl)
InsureLine Brokers (Platinum)
InsureLine Brokers (Premier)
InsureLine Brokers (Reliable)
InsureLine Brokers (Rise)
InsureLine Brokers (Royal)
InsureLine Brokers (Select)
InsureLine Brokers (Smart)
InsureLine Brokers (UNI)
InsureLine Brokers (VeriFive)
InsureLine Brokers (Viva)
InsureLine Brokers (Westgate)
InsureLine Marketing Systems
InsureLine Solutions
Termination Date
(Required)
MM slash DD slash YYYY
Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Reason for Offboarding
(Required)
--Please Select--
Resignation
Termination
Retirement
Maternal/Parental Leave
Medical Leave
Other
Other
Application Removal
Does the user have personally owned devices that need to be removed from Managed Services? (Provide computer name/serial number if known)
(Required)
Email
Who should have read and manage access to the user's mailbox?
(Required)
If an out of office reply is required, please enter it here.
Would you like new emails forwarded to a specific mailbox? If yes, please specify the recipient.
Phone
Please note - This is for Ubity and PortSIP ONE phones only
Do you want the phone extension and/or DID forwarded? If yes, then to which extension?
PandaDoc
Who should PandaDoc documents be transferred to?
Epic
Do you wish to retain the user license for future use? (Yes – retain / No – release)
(Required)
--Please Select--
Yes - Retain the license so I can assign in the future to another user. I understand that I will be billed monthly for the unassigned license.
No - Should I require the license in the future, I will be charged $500 for another license to be created.
Is a workload reassignment required?
(Required)
--Please Select--
Yes
No
Who should tasks and activities be assigned to?
Which servicing role should be reassigned?
--Please Select--
CSR
Producer
Both
Who should the client level CSR role be reassigned to?
(Required)
Who should the policy level CSR role be reassigned to?
(Required)
Who should the client level producer role be reassigned to?
(Required)
Who should the policy level producer role be reassigned to?
(Required)
Additional Notes
Applied Rating Services
Who should open items be transferred to?
Please note, if this is left blank they will be transferred to the terminated users manager
Notes