Real Estate Salesperson Transfer Form - ct
CPRTR-01, REV 1/19
STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION
LICENSE SERVICES DIVISION 450 Columbus Blvd, Ste 801 Hartford, CT 06103 Email: dcp.licenseservices@ Website : dcp
For Official Use Only
Real Estate Salesperson Transfer Form
Instructions 1. All sections on this form must be completed by the individual applying for transfer and the sponsoring broker. 2. A check or money order in the amount of $25.00 made payable to "Treasurer, State of Connecticut"
must accompany this form. 3. This completed form and fee must be received and processed by this department before you can represent a
new broker. 4. An updated license certificate will be mailed to the main office of the sponsoring broker as indicated below. 5. Connecticut licensed Real Estate Brokers are not required to complete this form and submit a fee. 6. Mail this completed form and fee to the above address.
SALESPERSON INFORMATION
First Name
Middle Initial Last Name
Street Address
City
State
Zip Code
Email Address to be used for correspondence
Telephone Number
Real Estate Salesperson License Number to be Transferred: RES #:
I request that my active real estate salesperson license be transferred to the sponsoring broker listed below.
Signature of Real Estate Salesperson
Date
SPONSORING BROKER INFORMATION
Legal Name of Sponsoring Broker
Street Address
City
Email Address to be used for correspondence
I accept the sponsorship of the licensed real estate salesperson listed above.
Signature of Sponsoring Broker
Print Name of Sponsoring Broker
Sponsoring Broker License #
State
Zip Code
Telephone Number
Date
................
................
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