Change of Business Entity (Agency) Information
This form must be submitted to the Insurance Department within thirty (30) working days of any changes in an agency’s Designated Responsible Licensed Person (DRLP) or DBA name. All other changes in addresses, names, email and other contact information must be submitted online via NIPR. Failure to report such changes may result in action against the agency's license. This form is not to be used for changes in information for individual licensed producers.