Arkansas Insurance Department
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License Forms and Electronic Filings
(CLICK ON THE CATEGORY OF FORM YOU NEED)
ADDRESS HEALTH CONNECTOR PRODUCER
ADJUSTER HEALTH EXCHANGE AGENCY RENTAL CAR
AGENCY AFFILIATIONS/TERMINATIONS LICENSE RENEWAL SELF-SERVICE STORAGE
APPOINTMENTS LICENSE SURRENDER SELF, TRUST, MET, MEWA
ASSUMED BUSINESS NAME LIFE SETTLEMENT SURPLUS LINES
BUSINESS ENTITY (AGENCY) MANAGING GENERAL AGENT SURPLUS LINES BUSINESS ENTITY
CONSULTANTS MOTOR CLUB THIRD PARTY ADMINISTRATOR
CROP ADJUSTER - LIMITED LINES NAME CHANGE TITLE
EMAIL ADDRESS PORTABLE ELECTRONIC INSURANCE VIATICAL
LINKS TO ON-LINE CHANGE OF ADDRESS, LICENSE APPLICATIONS, LICENSE RENEWALS, APPOINTMENTS AND TERMINATIONS
IMPORTANT NOTICE:  THE STATE BASED SYSTEMS (SBS) LINKS BELOW ARE SCHEDULED TO GO LIVE ON 10/20/14;THE NATIONAL INSURANCE PRODUCER REGISTRY (NIPR) LINKS ARE SCHEDULED TO GO LIVE ON 10/27/14. FOR MORE INFORMATION SEE BULLETIN 12-2014.
ATTENTION: When selecting the National Insurance Producer Registry (NIPR) or State Based Systems (SBS) links below, you will leave the Insurance Department website. If you have questions or problems with your transaction on the NIPR or SBS website, you will need to contact their help line for assistance.
 
NIPR HELP DESK (855) 674-6477
customerservice@nipr.com
SBS Help Desk (816) 783-8990
  • Change of Address (NEW), Resident and Nonresident License Renewals, Resident and Nonresident Direct Appointments,  Agency Appointments, License Renewals, New Agencies, New Producer Applications, Appointments: NIPR.
  • NAIC/NIPR Attachments Warehouse: Bulletin No. 13-2009

Name

Number

Apply Online

Paper Filings

ADDRESS:  (RETURN TO TOP)

Address Change Form
AID-LI-AC NIPR SBS WORD PDF
AGENCY AFFILIATIONS & TERMINATIONS
Addition and Termination Instructions
     WORD  PDF
Producer Addition
AID-LI-AGY-ADD    WORD PDF
Producer Termination
AID-LI-UBE-TERM    WORD PDF

APPOINTMENTS:    (Agency and Individual)                                                   (RETURN TO TOP)

NAIC Uniform Appointment/Termination Instructions
     WORD  PDF
NAIC Uniform Agent Appointment/Termination Form
AID-LI-APT-TERM NIPR WORD PDF
Add or Remove a Line of Authority from an Appointment
  NIPR  PDF FORM

ASSUMED BUSINESS NAME:  

Filing Form
AID-LI-ANF   WORD   PDF

BUSINESS ENTITY (AGENCY):  (RETURN TO TOP)

ELECTRONIC APPLICATION
NIPR
Business Entity Instructions
    WORD  PDF
Business Entity Uniform License Application
AID-LI-UBE NIPR WORD PDF
Business Entity Name Change Instructions
    WORD  PDF

CROP ADJUSTER:            

Limited Lines Crop Adjuster Application and Instructions
 AID-LI-CROP/ADJ    WORD  PDF
EMAIL ADDRESS:
ELECTRONIC EMAIL MAINTENANCE
SBS
HEALTH CONNECTOR:
(IPA Guide, Navigator, Certified Application Counselor, Exchange Producer)
Health Connector License Application and Instructions
AID-AHC-HC    WORD PDF
Health Connector License Renewal Form
AID-AHC-ARF-HC     WORD PDF
HEALTH EXCHANGE AGENCY:
Health Exchange Agency Application and Instructions
AID-LI-HEA   WORD PDF

LICENSE RENEWAL:  (RETURN TO TOP)

ELECTRONIC LICENSE RENEWAL     (2014 Renewal Fees)
 NIPR   
Replacement License Renewal for Producers
AID-LI-ARF-RP NIPR WORD PDF
Replacement License Renewal for Business Entities
AID-LI-ARF-RBE NIPR WORD PDF
Request for Waiver of Late Renewal Penalty
AID-LI-WAV    WORD PDF
LICENSE SURRENDER:  
License Surrender Form
AID-LI-LS   WORD PDF

LIFE SETTLEMENT:   (RETURN TO TOP)

Instructions 
       WORD PDF
Life Settlement Broker Individual
AID-LI-LSBI   WORD PDF
Life Settlement Broker Business Entity
AID-LI-LSBE   WORD PDF
Life Settlement Producer Notice
AID-LI-LSPN   WORD PDF
Life Settlement Provider Applications Are Processed By Our Life & Health Division
Life & Health Division 

MANAGING GENERAL AGENT:  

License Instructions
       WORD PDF
License Application
AID-LI-MGA40   WORD PDF
Company Appointment
AID-LI-MGA41   WORD PDF
Termination of Company Appointment
AID-LI-MGA42   WORD PDF
Bond
AID-LI-MGA43    WORD PDF 
Contract
AID-LI-MGA45   WORD PDF

MOTOR CLUB

License Instructions / Application
AID-LI-RP MOTOR CLUB    WORD  PDF
NAME CHANGE
Individual Licensee Name Change Form and Instructions
AID-LI-NC   WORD PDF 
PORTABLE ELECTRONIC INSURANCE:       
License Instructions
     WORD  PDF
Portable Electronic Insurance Application (More than 10)
AID-LI-PEI   WORD PDF
Portable Electronic Insurance Limited Application (10 or Less)
AID-LI-PEI-LIMITED   WORD  PDF

PRODUCER (INCLUDES ADJUSTER, CONSULTANT AND SURPLUS LINES):   (RETURN TO TOP)

ELECTRONIC APPLICATION
NIPR
Testing and License Instructions
   WORD PDF
Application

NIPR WORD PDF
Criminal Background Form
ASP-122 WORD PDF
Moving to Arkansas (Change from Nonresident to Resident)
AID-LI-COR    WORD PDF
Add or Remove a Line of Authority From An Active License
AID-LI-ADRM    WORD PDF
Request to Reinstate License
AID-LI-REINSTATE NIPR WORD PDF
Emergency Temporary License Instructions
   
WORD PDF

RENTAL CAR: 

Rental Car Company Application
AID-LI-CAR   WORD PDF

SELF, TRUST, MET, MEWA: 

Registration  Instructions
    WORD PDF
Self-Funded Single Employer Plans, Collectively Bargained Welfare Benefit Plans, Multiple Employer Trusts and Multiple Employer Welfare Arrangements Registration Form
AID-LI-SELF   WORD PDF
SELF-SERVICE STORAGE:
Self-Service Storage License and Instructions
AID-LI-SSS   WORD  PDF

SURPLUS LINES BUSINESS ENTITY: (RETURN TO TOP)

Producer for Business Entity License Instructions
    WORD PDF
Producer for Business Entity Application
AID-LI-SLBE   WORD PDF
Broker/Producer Bond
AID-LI-SLBB   WORD PDF
Add Producer to Surplus Lines Agency
AID-LI-SLAgency-Add   WORD PDF
Filing Forms and Instructions
FILING FORMS 

THIRD PARTY ADMINISTRATOR:  (RETURN TO TOP)

Registration  Instructions
      WORD PDF
Registration Application
AID-LI-TPA   WORD  PDF
Bond
AID-LI-TPA-BOND   WORD  PDF

TITLE: 

Summary of Fees
      WORD PDF
New Title Agent Instructions
    WORD PDF
Title Agent Application
AID-LI-TA   WORD PDF
Title Agent Replacement Renewal (ARF) 
AID-LI-RTA   WORD PDF
New Title Agency Instructions
    WORD PDF
Title Agency Application
AID-LI-TAGY   WORD PDF
Title Agency Replacement Renewal
AID-LI-ARF-TI-AGY-R   WORD PDF
Addition and Termination Instructions
    WORD PDF
     Producer Addition 
AID-LI-AGY-ADD-TI   WORD PDF
     Producer Termination
AID-LI-AGY-TERM-TI   WORD PDF
Title Insurance Continuing Education
Courses and Providers (SBS) 

VIATICAL: (RETURN TO TOP)

See Life Settlement Above