Fillable SALESPERSON ONLINE REINSTATEMENT SPONSORING BROKER FORM (State of Connecticut/Department of Administrative Services)

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SALESPERSON ONLINE REINSTATEMENT SPONSORING BROKER FORM (State of Connecticut/Department of Administrative Services)

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BROWSE STATE OF CONNECTICUT/DEPARTMENT OF ADMINISTRATIVE SERVICES (CT) FORMS

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FOR ONLINE REINSTATEMENT USE ONLY
STATE OF
CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
L
ICENSE
S
ERVIC E S
D
IVISION
Email: dcp.licenseservices@ct.gov
Website: www.ct.gov/dcp
SALESPERSON ONLINE REINSTATEMENT SPONSORING BROKER FORM
INSTRUCTIONS: Salesperson, please complete Section I and have your sponsoring broker complete Section II. This form must be
uploaded to your online reinstatement.
SECTION I: SALESPERSON INFORMATION
First Name Middle Initial Last Name
Email Address CT Salesperson License #:
RES.
________________________
SECTION II: SPONSORING BROKER INFORMATION
Legal Name of Sponsoring Broker Sponsoring Broker CT License #:
REB.
________________________
_
Street Address City State Zip Code
Email Address Telephone Number
I accept sponsorship for the real estate salesperson listed above.
Signature of Sponsoring Broker Date
Printed Name of Sponsoring Broker
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SALESPERSON ONLINE REINSTATEMENT SPONSORING BROKER FORM (State of ConnecticutDepartment of Administrative Services)

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Completed 5 February 2022

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