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AGENTS & BROKERS: Frequently Requested Agent Licensing Forms

Listed below are the Producer Licensing Bureau's frequently requested agent licensing forms. These forms are available only in Adobe's Portable Document Format (PDF). To view and complete these pdf forms on your browser you must have Adobe Acrobat Reader on your computer. A free copy of the Adobe Acrobat Reader can be downloaded from the Adobe website. Additional forms will be added or revised periodically, so keep checking back. For instructions on completing the forms please click on the name of the form. All forms on this page are interactive. Many of these forms can now be filed using various online services.

Form Title	Download form here PDF Format
Action Notice of Appointment To submit appointments electronically contact the National Insurance Producer Registry (NIPR) and its authorized business partners for a list of approved partners.	LIC 447-54A
Action Notice of Termination To submit terminations electronically contact the National Insurance Producer Registry (NIPR) and its authorized business partners for a list of approved partners.	LIC 447-54T
Background Information Change Disclosure Form	LIC 2557B
Business Entity Endorsement Appointment Business Entity Endorsement and Termination Online Service (This service is available for most but not all all license types)	LIC 411-8A
Business Entity Endorsement Termination Business Entity Endorsement and Termination Online Service (This service is available for most but not all all license types)	LIC 411-8T
Business Entity License Application Business Entity Online License Application (This service is available only for Fire and Casualty Broker-Agent, Life-Only Agent and Accident and Health Agent license types)	LIC 441-11
Change of Address Change your Address Online (If you are changing states, please use Form LIC 447-7)	LIC 447-7
Fire and Casualty Broker Bond	LIC 417-5
Individual Insurance License Application Fast Licensing Application Service is Here (FLASH) (This service is available for most but not all all license types)	LIC 441-9
Renew Individual License Application Free Application Online Renewal Service (This service is available for most but not all all license types)	LIC 448-29A
Renew Business Entity License Application Free Application Online Renewal Service (This service is available for most but not all all license types)	LIC 448-29B
Request for Certificate of License Status Print your own Certificate License Status	LIC 780

If you have any questions about the license information you retrieved, please see the most commonly asked questions in our License Questions and Answers section. If you need further assistance, please call CDI's License Bureau at (800) 967-9331, or send an e-mail to Producer Licensing Bureau. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the CDI.

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