License Applications | License Renewal | Additional Applications | Forms
Producer License Applications
Additional License Applications
Corporate Insurance Consultant's License
Independent Review Organization Application
Insurance Consultant License Application
Limited Lines Travel Insurance Agency Application
Limited Lines Travel Insurance Agency Certification Form
Managing General Agent Application
Motor Club Representative Registration
Portable Electronics Insurance Agency License Application
Pre-Need Agent and Seller Application
Rental Car Agency Limited License Application
Utilization Review Agent Application
Viatical Settlement Broker Entity
Viatical Settlement Broker (Life Licensed)
Forms
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.
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.
Form 9002A - Designated Responsible Licensed Producer Amendment Form
Financial Disclosure Statement - Title Insurance Agent
Title Insurance - Bond Form for Escrow Agents
Veterans Application for Reimbursement of Licensing or Certification Test Fees
