Licensing Forms and Fees

Use the index below to go directly to a particular section on this page:

• License Fees
• Entity Fees
• Online Services

The following is a list of licensing forms and fees. Forms can be downloaded. Applications can be downloaded or completed electronically on SIRCON/Vertafore or NIPR.

• Non Resident Adjuster Affidavit - Form
  (Updated 07/01/18)
• Risk Purchasing Group - Form
• Risk Retention Group - Form
• Public Adjuster E&O Coverage Certification - Form
• Public Adjuster Surety Bond - Form
• Profession Bail Bond Agent Financial Report - Form
• Limited Surety Appointment Form - Form
• Personal Security - Irrevocable Security Power - Form
• Viatical Settlement Provider Affidavit - Form
• Change of Address - Form, Online (Sircon/Vertafore or NIPR)
• Entity Change of Address - Form
• Certificate of Authority (appointment) - $25.00 - Form
• Duplicate License - $25.00 - Form, Online
• Letter of Certification (Letter of Good Standing) - $20.00 - Form, Online
• Letter of Clearance - $20.00 - Form
• License Amendment - $25.00 - Individual Form, Online
• License Amendment - $50.00 - Entity Form, Online

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License Fees

• Automobile Club - $5.00
• Bail Agent, Professional - $100.00
  • Limited Surety
  • Personal Surety
• Bail Enforcement or Soliciting Agent - $40.00
• Burial Agent - $5.00
• Legal Agent - $10.00
• Insurance Producer - $100.00
  • Life, Accident & Health
  • Property
  • Casualty
  • Personal Lines
  • Variable Life and Variable Annuity Products
• Limited Line Credit Insurance Producer - $100.00
• Limited Lines Insurance Producer - $100.00
  • Industrial Fire
  • Industrial Life Accident and Health
  • Surety
  • Title
  • Trip Accident and Baggage
  • Car Rental
  • Crop
  • Travel
• Managing General Agent (individual) - $100.00
• Reinsurance Intermediary Managers/Brokers (individual) - $50.00
• Risk Retention Agent - $50.00
• Supervising General Agent (individual) - $100.00
• Surplus Lines Insurance Producer - $100.00
• Temporary Limited Lines Insurance Producer - $100.00
• Temporary Insurance Producer - $100.00
• Viatical Settlement Representative or Broker - $50.00
• Individual Adjuster fees - $100.00
  • Independent Adjuster
  • Emergency
  • Trainee
  • Public Adjuster
  • Emergency Public Adjusters
  • Public Adjuster Trainee

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Entity Fees

• Independent Adjuster Entity - $400.00
• Public Adjuster Entity - $400.00
• Insurance Producer Entity - $200.00
• Limited Lines Insurance Producer Entity - $200.00
• Limited Line Credit Insurance Producer Entity - $200.00
• Managing General Agent Entity - $100.00
• Portable Electronics Insurance Producer Business Entity - $5,000.00
• Reinsurance Intermediary Manager or Broker Entity - $100.00
• Supervising General Agent Entity - $100.00
• Third Party Administrator - $200.00
• Transportation Network Company(TNC) - $5,000
• Viatical Settlement Entity Representative or Broker (entity) - $50.00
• Viatical Settlement Provider - $200.00

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Online Services

The following services are available online at Sircon/Vertafore:

• Change of Address (Also available at NIPR)
• Letter of Certification
• Agent/Producer License Transcript
• Maintain Agent/Firm Associations
• Find your License Number or National Producer Number (NPN)
• Check your Continuing Education Status
• Check your Application Status
• Update your email address

The following services are available online at NIPR:

• Apply for a license
• Renew or reinstate your license
• Address change request
• Update your address
• Update your email address

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