Use the index below to go directly to a particular section on this page:
List of Licensing Forms and Fees
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
- 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)
- 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
- 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:
The following services are available online at NIPR:
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