Arkansas Insurance Department
IMPORTANT NOTICE:  Effective October 10, 2014, the License Division will halt all processing for approximately ten days while the Department converts to the NAIC State Based System (SBS). For more information see Bulletin 12-2014.
            Home
License Forms and Electronic Filings
(CLICK ON THE CATEGORY OF FORM YOU NEED)
ADDRESS LICENSE (ARF) REPLACEMENT / WAIVER SELF-SERVICE STORAGE
ADJUSTER LICENSE SURRENDER SELF, TRUST, MET, MEWA
APPOINTMENTS LIFE SETTLEMENT SURPLUS LINES
ASSUMED BUSINESS NAME MANAGING GENERAL AGENT THIRD PARTY ADMINISTRATOR
BUSINESS ENTITY (AGENCY) NAME CHANGE TITLE
CONSULTANTS PORTABLE ELECTRONIC INSURANCE VIATICAL
HEALTH CONNECTOR PRODUCER (AGENT, BROKER, CONSULTANT)
HEALTH EXCHANGE AGENCY RENTAL CAR
LINKS TO ON-LINE CHANGE OF ADDRESS, RENEWALS, APPOINTMENTS AND TERMINATIONS
ATTENTION: When selecting the National Insurance Producer Registry (NIPR) or LEO links below, you will leave the Insurance Department website. If you have questions or problems with your transaction on the NIPR or LEO website, you will need to contact their help line for assistance.  
NIPR HELP DESK (855) 674-6477
customerservice@nipr.com
LEO SUPPORT LINE (646) 863-0963
  • Change of Address (NEW), Resident and Nonresident License Renewals, Resident and Nonresident Direct Appointments, Resident and Nonresident Agency Shared Appointments, Resident and Nonresident Agency Affiliations and Terminations of Affiliations of Producers: Leo Online Service
  • Nonresident License Renewals, New Nonresident Agencies, New Nonresident Producer Applications, Direct Appointments: National Insurance Producer Registry (NIPR).
  • NAIC/NIPR Attachments Warehouse: Bulletin No. 13-2009

License Form Name

Number

Link

ADDRESS:  (RETURN TO TOP)

Address Change Form
AID-LI-AC WORD PDF
On-line Address Change Form

Leo Online Services

NIPR

ADJUSTER:                                                                         

Application and Instructions  
AID-LI-ADJ
Non-Resident License & CE Requirements
WORD PDF
Limited Lines Crop Adjuster Application and Instructions
AID-LI-CROP/ADJ WORD PDF

APPOINTMENTS:   (RETURN TO TOP)

NAIC Uniform Appointment/Termination Instructions
  WORD PDF
NAIC Uniform Agent Appointment/Termination Form
AID-LI-APT-TERM WORD PDF
Add or Remove a Line of Authority from an Appointment (Agent or Agency)
  PDF FORM
On-line Agent/Agency (Electronic) Appointments
Leo Online Services
Agency Appointment/Amended Appointment Instructions
   PDF
Agency Appointment
AID-LI-I48-AGENCY PDF FORM
Amend Agency Appointment
AID-LI-I48-A PDF FORM
Agency Appointment Termination Instructions
  PDF
Agency Appointment Termination Form and 
Agent Appointment Termination Under Agency Form
AID-LI-I71 PDF FORM

ASSUMED BUSINESS NAME: 

Filing Form
AID-LI-ANF WORD PDF

BUSINESS ENTITY (AGENCY):  (RETURN TO TOP)

Resident Business Entity Instructions
  WORD PDF
Resident Business Entity Uniform License Application
AID-LI-UBE WORD PDF
Non-Resident Business Entity Instructions
NIPR
Non-Resident Business Entity Uniform License (Paper) Application
NIPR
Addition and Termination Instructions
  WORD PDF
     Producer Addition
AID-LI-AGY-ADD PDF FORM
     Producer Termination
AID-LI-UBE-TERM WORD PDF
Business Entity Name Change Instructions
  WORD PDF

CONSULTANTS:

     
Consultant Instructions
  WORD PDF
Consultant Application
AID-LI-CA WORD PDF
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 (ARF) REPLACEMENT:  (RETURN TO TOP)

Replacement License Renewal for Producers, Adjusters, and Consultants
AID-LI-ARF-RP WORD PDF
Replacement License Renewal for Business Entities
AID-LI-ARF-RBE 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
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 (Agent, Broker, Consultant): (RETURN TO TOP)               ***  PRODUCER APPLICATION CHECK LIST  ***

Resident Testing and License Instructions / Application
AID-LI-RP
Handbook
Testing Calendar
WORD PDF
Resident Limited Lines License Instructions
 AID-LI-RP 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 WORD PDF
Emergency Temporary License Instructions
  WORD
PDF
On-line Resident and Non-Resident License Renewal
Leo Online Services
Non-Resident Uniform License Instructions
NIPR
Non-Resident Uniform (Paper) License Application
NIPR
On-line Non-Resident (Electronic) License Application
NIPR
On-line Non-Resident (Electronic) License Renewal
NIPR

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:
PDF FORM
Self-Service Storage License and Instructions
AID-LI-SSS WORD PDF

SURPLUS LINES: (RETURN TO TOP)

Broker/Producer Testing and License Instructions
Testing Calendar WORD PDF
Broker/Producer License Application
AID-LI-SLB WORD PDF
Producer for Business Entity Application
AID-LI-SLBE WORD PDF
Broker/Producer Bond
AID-LI-SLBB WORD PDF
Producer for Business Entity License Instructions
  WORD PDF
Producer for Business Entity Application
AID-LI-SLBE 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

VIATICAL: (RETURN TO TOP)

See Life Settlement Above