Nebraska Department of Insurance
PRODUCER LICENSING APPLICATIONS
The following is a listing of licensing forms available for printing. If you have questions concerning these forms or other licensing matters, you can e-mail the Licensing Division. If you have problems accessing these forms, e-mail the Webmaster.
Have questions concerning producer or agency licensing or continuing education matters?
Check our Frequently Asked Questions.
Printing Instructions
Selecting a form below will load it into the acrobat reader, which will allow you to print it. Install the Acrobat Reader if you do not yet have it installed on your computer. Any instructions needed to complete the licensing forms are included with each form.Resident Producer License
or
Nonresident Producer License (paper submission)
Electronic Non-Resident Producer License (through NIPR)
Insurance Agency License
Utilization Review Agent
Managing General Agent
Viatical Settlement Broker
Includes the following:
Memorandum - Viatical Settlement Broker and Provider Licensing
Procedures to Obtain a Viatical Settlement Broker License
Declaration to Nebraska Department of Insurance for Viatical Settlement Agent or Broker
Individual Resident/Nonresident Producer and Viatical Settlement License Application
Viatical Settlement Broker Entity
Includes the following:
Memorandum - Viatical Settlement Broker and Provider Licensing
Declaration to Nebraska Department of Insurance for Viatical Settlement Agent or Broker
Viatical Settlement Broker Business Entity License Application
Insurance Consultant's License
Includes the following:
Requirements and Procedures for Obtaining an Insurance Consultant's License - Resident and Nonresident
Corporate Insurance Consultant's License
Includes the following:
Requirements and Procedure for Obtaining a Corporate Insurance Consultant License - Resident and Nonresident
Change Request
Address Change Request form via NAIC
Application for Limited License for Sale of Insurance related to Rental Vehicles
Includes instructions.
Midwest Zone Appointment/Termination Form
Includes instructions and form. (PDF file can be saved to your computer. You can complete the form on the screen, print it and save it, and send it to the Department.)
Retaliatory Appointment Fees as of March 6, 2007
Retaliatory Appointment Fees as of March 6, 2007
National Insurance Producer Registry (NIPR)
Link to the NIPR web site that includes e-mail addresses concerning questions for NIPR, PDB, PIN, and
Non-Resident Licensing.