NAIC uniform license application for an Individual

To make your application process faster and easier, use NIPR.COM and apply online instead of completing, printing and mailing this application

Priority: 
LI10000

Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an naic.org or gmail.com email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].

Form L-FPV: Fingerprint Verification

This form is to be used by individuals who are required to submit fingerprints as part of an insurance license application. The form includes detailed instructions that must be exactly followed for fingerprints to be accepted by the Department of Insurance.

Form L-LOC: Branch Locations

Self Service Storage Agents and Rental Car Agents must specify all office locations from which the entity may transact insurance business.

Form L-LSB: Life Settlement Broker Application

Complete and file this form with the life settlement broker license fee within the first 30 days of operating as a life settlement broker. 

Form L-LTD: Limited License Authority Application

Only use this form to apply for a license as a portable electronics vendor, rental car agent, self-service storage agent, or travel insurance producer. 

Form L-NAV: Application for Navigator or Certified Application Counselor License

The document contains detailed instructions and forms to apply to become a navigator or certified application counselor. 

Form L-PFD: Petition for Determination

You can use this form to ask the Department of Insurance to determine whether a criminal conviction disqualifies you for a license.  

Form L-SURR: License Surrender Request

Only use this form to permanently surrender license authority.  If you wish to clear a license to allow you to become licensed in another state, use Form L-CLR.

Form L-TEMP: Application for a Temporary Insurance License

Submit

  • Form L-TEMP,
  • Form L-152 with a copy of both sides of one of listed forms of identification,
  • Fingerprints and Form L-FPV exactly as described on Form L-FPV, and
  • $142.00 (to cover the $120.00 license fee and $22.00 FBI fingerprint card processing fee). 
NAIC Form 11: Biographical Affidavit

Must be completed by each partner, officer, and director, and each other entity owning 25% or more of a Service Company applicant.

Form RO31010: License Application for a Rating Organization
Form RSO31010: License Application for a Rate Service Organization

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