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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 3.0 or higher 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.

Form Title

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PDF Format

Action Notice of Appointment  LIC 447-54A 
Action Notice of Termination LIC 447-54T 
Background Information Change Disclosure Form LIC 2557B 
Business Entity Endorsement Appointment LIC 411-8A 
Business Entity Endorsement Termination LIC 411-8T 
Business Entity License Application   LIC 441-11 
Change of Address LIC 447-7 
Fire and Casualty Broker Bond  LIC 417-5
Individual Insurance License Application LIC 441-9 
Renew Individual License Application LIC 448-29A 
Renew Business Entity License Applications LIC 448-29B 
Request for Certificate of 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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