Official Nebraska Government Website  

Nebraska Department of  Insurance

consumer producer company


 




Licensing Applications & Forms


Producer License Applications




Producer License Renewals



Additional License Applications

Viatical Settlement Broker Entity

Viatical Settlement Broker - Life Licensed

Viatical Settlement Broker - Not Life Licensed

Rental Car Agency Limited License Application

Portable Electronics Insurance Agency License Application

Limited Lines Travel Insurance Agency Application

Limited Lines Travel Insurance Agency Certification Form


Forms

Licensing Fee Schedule

Form 9110 - Change Request Form for Producers and Consultants This form can be used for Address and name changes, Line of Authority changes, Correcting SSN information, and Letter of Clearance requests

Agency Change Request Form

Producer License Renewal Form

Form 9002A - Designated Responsible Licensed Producer Amendment Form

Financial Disclosure Statement - Title Insurance Agent

Bond Form for Escrow Agents

Retaliatory Appointment Fees

Veterans Application for Reimbursement of Licensing or Certification Test Fees

Any instructions needed to complete the licensing forms are included with each form. If you have questions concerning these forms or other licensing matters, you can e-mail the Licensing Division. If you have problems accessing these forms, e-mail the Webmaster.