Licensing Applications & Forms | Nebraska Department of Insurance

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, DOI.Licensing@nebraska.gov. If you have problems accessing these forms, e-mail the Webmaster, DOI.webmaster@nebraska.gov.

Licensing Fee Schedule

Form 9110 - Change Request Form for Individuals – This form can be used for address and name changes, line of authority changes, and correcting SSN information.

Apprentice License Application

Agency Change Request Form

Travel Agency – Authorized Retailer Form

License Cancellation Request Form

Viatical Settlement Broker Declaration Form

Navigator Individual Registration

Managing General Agent Bond Form

Surplus Lines Agency Affiliation Form

Form 9002A- Designated Responsible Licensed Producer Amendment Form

Financial Disclosure Statement - Title Insurance Agent

Title Insurance - Bond Form for Escrow Agents

Nebraska Retaliatory Appointment Fees