MEDICAL/MILITARY EXTENSION REQUEST

Pursuant to K.S.A. 40-4903 (e)(4) the Commissioner of Insurance may extend the time within which a licensee must complete his or her biennial continuing education and renewal requirements in cases involving medical hardship or military service. Please complete the following information to request an extension for renewal of your insurance producer license. Extensions may not exceed a period of 180 days. All fields are required.

Name:  
Address: 
        
          
Email: 
NPN: 

Reason for Extension: 

Please email documentation supporting your request to the Producer Licensing Division at kid.licensing@ks.gov with "Extension Request" in the subject line. The Department will not act on your request until the required documentation is received.

If all the above information is correct, please press the Submit button.