Nebraska Department of Insurance
DEPARTMENT FORMS
PRODUCER (AGENT) LICENSING FORMS
Check our Frequently Asked Questions.
Resident and Non-Resident Online Application and Renewal Process
The Nebraska Department of Insurance's preferred method of license application and renewal for the products below is through the online process at www.nipr.com.
- Resident License and Renewal for Individuals
- Non-Resident License and Renewal for Individuals
- Resident License and Renewal for Business Entities
- Non-Resident License and Renewal for Business Entities
- Non-Resident License for Business Entities
- Resident and Non-Resident Reinstatements for Individuals and Business Entities
- Address Change Request form
- CE lookup and CE transcript lookup (via SBS)
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Resident Producer License (Includes Surplus Lines license application)
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Nonresident Producer License (paper submission) (Includes Surplus Lines license application)
- Electronic Non-Resident Producer License (through NIPR)
- Insurance Agency License (Includes Surplus Lines license application)
- Utilization Review Agent
- Managing General Agent
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Viatical Settlement Broker
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Includes the following:
- Procedures to Obtain a Viatical Settlement Broker License
- Declaration to Nebraska Department of Insurance for Viatical Settlement Agent or Broker
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Viatical Settlement Broker Entity
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Includes the following:
- Viatical Settlement Broker Business Entity License Application
- Insurance Consultant's License
- Includes the following:
- Requirements and Procedures for Obtaining an Insurance Consultant's License - Resident and Nonresident
- Corporate Insurance Consultant's License
- Includes the following:
- Requirements and Procedure for Obtaining a Corporate Insurance Consultant License - Resident and Nonresident
- Change Request
- Form 9110 - Request Form for Producers and Consultants
- Rental Car Limited License Instructions and Application
- Portable Electronics Insurance Agency License Instructions and Application
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National Insurance Producer Registry (NIPR)
- Link to the NIPR web site that includes e-mail addresses concerning questions for NIPR, PDB, PIN, and Non-Resident Licensing.
COMPANY APPLICATION/LICENSING FORMS
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Third Party Administrator Packet
- Form TPA - Application for Certificate of Authority
Includes instructions and the following form:
- Pre-Need Applications and Forms
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Viatical Settlement Provider Application
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Includes the following:
- Memorandum - Viatical Settlement Broker and Provider Licensing
- Viatical Settlement Provider Application
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Purchasing Group-Notice and Registration Form
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Includes the following:
- Memorandum - Requirements Under Liability Risk Retention Act of 1986 and Nebraska Risk Retention Act
- Uniform Registration Form - Purchasing Group-Notice and Registration
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Utilization Review Agent
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Form 12: Changes or additions to the Uniform Consent to Service of Process form
- Changes or additions to the Agent for Service of Process for Nebraska-licensed companies may be accomplished by completion and submission of the NAIC Uniform Certificate of Authority (UCAA) Form 12.