NOTICE - Statement for Producers' Annual Appointment Renewals

The enclosed annual renewal billing statement reflects the producers’ appointments renewed on behalf of your company for the 2010-2011-license year. You may not add or delete names to/from the billing statement.

Appointments and appointment terminations may be processed online through the National Insurance Producer Registry (NIPR) at, or by submitting the NAIC Uniform Appointment/Termination form found on the Department’s website at

Cancellation of Producers’ Appointments

Cancellation of Producers’ Appointment forms received in the Department after April 15, 2010 were automatically renewed and have been processed with a cancellation effective date of May 1, 2010. Both the renewal statement and the cancellation fees listed on your May or June monthly invoice must be paid.

Questions concerning your annual renewal statement may be directed to the Department at 402-471-4913.

Remit the total amount due by the date indicated and include a copy of the first page of the invoice with your check. Appointment renewals are not available for processing online.

Any other money that may be due the Department should be remitted by a separate check.



Form 3109