Request To Remove Licensee From Broker Supervision

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Please Note: The Commission should receive a new properly completed Request for BIC Eligible Status and/or BIC Designation form (REC 2.25) prior to the removal of a Broker-in-Charge. Otherwise, when a Broker-in-Charge is removed from a firm, the licenses of provisional brokers with that firm will be placed on Inactive Status and the addresses of record for both provisional brokers and “full” brokers will be changed to their residence addresses.
Click here to access the Request for BIC Eligible Status and-or Broker-In-Charge Designation (REC 2.25) online form.

License Details

Effective Date of Change*

Name of Licensee to be removed*

License Number*

Name of QB or BIC*

License Number*

Firm Information

Firm Type*

Firm Name*

Firm License Number*

Public Phone

Private Phone*

Public Email

Private Email*

Signature and Certification

By signing below, you are acknowledging that the above referenced licensee is no longer affiliated with your firm.

Signature Required*

(Type your name)

Date Signed

12/21/2024

You must complete the reCaptcha below before submitting this form*

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