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California Department of Insurance Producer Licensing Bureau
License Name Change Request California Insurance Code Section 1650 and 1666.5
300 Capitol Mall 16th floor Sacramento, CA 95814-4309 (800) 967-9331 www.insurance.ca.gov
LIC 075 (Rev. 09/2022)
This request is only valid for insurance license applicants and individuals who hold an insurance license issued by the California Department of Insurance. This form may not be used for business entities requesting a name change. Business entities should contact our Business Entity Unit at (916) 492-3069 or email them at cdibena@insurance.ca.gov for further information.
The licensee's National Producer Number (NPN) can be retrieved using the following link: NPN Lookup
Please allow 12 to 14 business days for processing this request.
License Number/Application ID Number and Email must match what is on file at CDI. Please click Back and correct on first tab.