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Paper Application and Exemption Forms

Most applicants will complete an application online through NIPR. 

If you are unable to apply online, please contact us for assistance.

Paper Fee
An extra $50 paper processing fee applies when you submit an application form that can be completed online.

  Producer   Adjuster   Managing General Agent   Motor Vehicle Service Contract   Reinsurance Intermediary   Third-Party Administrator   Viatical Settlement

Paper Renewal Forms

Most applicants will renew online through NIPR.

If you are unable to renew online, please contact us for assistance.

Producer, Surplus Lines, and Limited Adjuster Managing General Agent

Reinsurance Intermediary

  • NAIC Uniform Renewal Application - Note 'Reinsurance Intermediary Manager' or 'Reinsurance Intermediary Broker' at top of form. Must include $75 renewal fee + $50 paper processing fee.
Third Party Administrator

Viatical Settlement

  • Please contact the Division to obtain a duplicate copy of your renewal form.