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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 Free Documents Readers  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 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 license types)

  LIC 411-8T 

Business Entity License Application

Business Entity Online License Application
(This service is available only for Property Broker-Agent, 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 

Property and/or 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 license types)

  LIC 441-9 

Renew Individual License Application

Free Application Online Renewal Service
(This service is available for most but not 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 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.

Return to Producer Licensing Bureau Forms Main Page

 

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