REPORT CHANGES TO YOUR NAME, ADDRESS OR PHONE NUMBER

NIPR Change Information
Arizona Revised Statutes (ARS) § 20-286(C) requires an insurance professional (insurance producers and others) to report each of the following within 30 days:

  • A change to the licensee's residential, mailing or business address, e-mail address or telephone number.
  • An individual must use the NIPR Contact Change Request, which is offered by the National Insurance Producer Registry at no charge.
  • A business entity must submit Form L-CHG report a change the business entity's principal business address, or Form L-LOC to report changes to branch locations and associated designated responsible licensed producers. A business may mail or email completed forms.
  • The addition, change or removal of a business-entity licensee's members, directors, officers or designated producer.
  • Complete Form L-177 to report a new member, officer or director (regardless of whether the business entity is licensed as an Arizona resident or non-resident).
  • Complete Form L-CHG to report a new designated responsible licensed producer/adjuster.
  • ​​For an Arizona-resident business entity, each new member, officer or director must submit fingerprints to the Department of Insurance in accordance with the procedures outlined in Form L-FPV.
  • A change to the licensee's name.
  • An Arizona resident must submit Form L-CHG with a copy of both sides of the newly issued Arizona Driver License or Arizona Non-operating Identification showing the new name.
  • A nonresident must first execute the name change with the insurance department in the licensee's home state, and then submit Form L-CHG to the Arizona Department of Insurance.

Assumed Name / DBA

If you intend to do business under a name other than your legal name (called an "assumed name" or "DBA name"), complete and submit Form L-193 (Certificate of Assumed Business Name). Send completed forms by mail or by fax. Protect your assumed name by also registering it as a trade name with the Arizona Secretary of State. If you do not register a trade name, another person may register the name, which will force you to stop using the name.

License Expiration vs. License Surrender

If you no longer wish to be licensed as an insurance professional in Arizona, or if you are no longer involved in a particular line of insurance business, you can either allow your license or the line of authority expire and decide to not renew it; or, you can surrender your license or a line of authority on your license.

IMPORTANT! If you surrender license authority, you will not be able to apply for the surrendered license authority for at least one year. Surrendering a license is irrevocable - you cannot decide that it was a mistake. Arizona law does not provide an exception that will allow a person who surrendered license authority to reapply for the surrendered authority within one year. 

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].