Pursuant to 2021 amendments to K.S.A. 40-4903(c)(5), insurance producers who hold a life insurance license solely for the purpose of selling pre-need funeral insurance or annuity products shall affirm, on or before their biennial renewal date, that they transacted no insurance business other than pre-need insurance during the biennial period.

Pre-Need Only Insurance Producer Biennial Affirmation


NPN: 
Biennial Period:  to  

By submitting this form, I affirm that I did not transact any insurance business other than ‘Pre-Need’ insurance sales during the Biennial Period stated above.

You are also required to provide a certification from an officer of each company with which you are appointed that you did not transact any insurance business other than Pre-need insurance sales. In order to assist the Kansas Insurance Department with monitoring compliance with this requirement, please identify each company with which you hold an appointment to conduct insurance business:

Company Name: 
   
   
   
   
   
   
   
   
   
   

It is your responsibility to ensure companies with which you hold appointments submit the required certifications. Your license will not be renewed until certifications from each company listed above are received by the Department. If received after your biennial renewal date, you will be required to pay a reinstatement fee in order to renew your license.

Companies can access a form to utilize for this certification requirement here: Company Pre-Need Certification.

 By checking this box and submitting this form, I affirm that the information provided in this form is accurate and complete. I further affirm that I understand that providing any false information in this filing report, may subject me to administrative action against my license pursuant to K.S.A. 40-4909.

Date: 01/18/2022