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.

  • Risk Purchasing Group - form
  • Risk Retention Group - form
  • Public Adjuster E&O Coverage Certification - form
  • Public Adjuster Surety Bond - form
  • Annual Report for Professional Bail Agents - 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)
  • Notice of Producer/Adjuster Name Change - 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

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 - $50.00
    • Independent Adjuster
    • Emergency
    • Trainee
    • Public Adjuster
    • Emergency Public Adjusters
    • Public Adjuster Trainee

Entity Fees

  • Independent Adjuster Entity - $200.00
  • Public Adjuster Entity - $200.00
  • 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

Online Services

The following services are available online at Sircon/Vertafore:

The following services are available online at NIPR: