Arkansas Insurance Department
            Home
License Forms and Electronic Filings
ADDRESS LICENSE RENEWAL RENTAL CAR SELF-SERV STORAGE
ADJUSTER LICENSE SURRENDER SELF, TRUST, MET, MEWA
AGENCY AFFILIATIONS/TERMINATIONS LIFE SETTLEMENT SURPLUS LINES
APPOINTMENTS MANAGING GENERAL AGENT SURPLUS LINES BUSINESS ENTITY
ASSUMED BUSINESS NAME MOTOR CLUB THIRD PARTY ADMINISTRATOR
BUSINESS ENTITY (AGENCY) NAME CHANGE TITLE
CONSULTANTS PORTABLE ELECTRONIC INSURANCE VIATICAL
CROP ADJUSTER - LIMITED LINES PRODUCER
EMAIL ADDRESS REGULATORY HEALTH LINK
HEALTH EXCHANGE AGENCY REINSURANCE INTERMEDIARY
LINKS TO ELECTRONIC FILING HELP DESKS
When selecting State Based Systems (SBS) or National Insurance Producer Registry (NIPR) links below, you will be leaving the Insurance Department website. If you have questions or problems with your transaction on the SBS or NIPR website, please to contact their help line listed below for assistance.

SBS Help Desk (816) 783-8990, sbshelp@naic.org
NIPR HELP DESK (855) 674-6477, customerservice@nipr.com

NAIC/NIPR Attachments Warehouse:
 Bulletin No. 13-2009

Name

Electronic

Filing

Paper

Filing

ADDRESS:  (RETURN TO TOP)

Address Change Form
NIPR
SBS
AGENCY AFFILIATIONS & TERMINATION
Agency Affiliations & Terminations            USERS GUIDE
INA

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

NAIC Uniform Agent Appointment/Termination Form
NIPR
Add or Remove a Line of Authority from an Appointment
 NIPR

ASSUMED BUSINESS NAME:  

Assumed Business Name Form

PDF

BUSINESS ENTITY (AGENCY):  (RETURN TO TOP)

Business Entity Uniform License Application
NIPR
Business Entity Name Change Instructions
  PDF 
Business Entity Appointment Termination Request

PDF

CROP ADJUSTER:            

Limited Lines Crop Adjuster Application
 NIPR  
EMAIL ADDRESS:
Email Maintenance
SBS
HEALTH EXCHANGE AGENCY:
Health Exchange Agency Application and Instructions

PDF

LICENSE RENEWAL:  (RETURN TO TOP)

LICENSE RENEWAL     (Renewal Fees)
NIPR 
Replacement License Renewal for Producers
NIPR
Replacement License Renewal for Business Entities
NIPR
Request for Waiver of Late Renewal Penalty

PDF
LICENSE SURRENDER:  
License Surrender Form

PDF

LIFE SETTLEMENT:   (RETURN TO TOP)

Instructions 
   PDF
Life Settlement Broker Individual

WORD
PDF
Life Settlement Broker Business Entity

WORD
PDF
Life Settlement Producer Notice

WORD
PDF
Applications Are Processed By Our Life & Health Division
Life & Health Division

MANAGING GENERAL AGENT:  

License Instructions
   PDF
License Application

WORD
PDF
Company Appointment

WORD
PDF
Termination of Company Appointment

WORD
PDF
Bond

WORD
PDF
Contract

WORD
PDF

MOTOR CLUB

License Instructions / Application
 NIPR 
NAME CHANGE
Individual Licensee Name Change Form and Instructions

PDF
PORTABLE ELECTRONIC INSURANCE:       
License Instructions
   PDF
Portable Electronic Insurance Application (More than 10)

WORD
PDF
Portable Electronic Insurance Limited Application (10 or Less)

WORD
PDF

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

Testing and License Instructions

PDF
Application
NIPR
Criminal Background Form
ONLINE FORM
Moving to Arkansas (Change from Nonresident to Resident)

PDF
Add or Remove a Line of Authority From An Active License
NIPR
Request to Reinstate License
NIPR
Emergency Temporary License Instructions
  WORD
PDF
REGULATORY HEALTH LINK:
(IPA Guide, Navigator, Certified Application Counselor, Exchange Producer)
Regulatory Health Link License Application and Instructions

WORD
PDF
REINSURANCE INTERMEDIARY
Broker Checklist
   PDF
Manager Checklist
   PDF

RENTAL CAR: 

Rental Car Company Application

WORD
PDF

SELF, TRUST, MET, MEWA: 

Registration  Instructions
  PDF
Self-Funded Single Employer Plans, Collectively Bargained Welfare Benefit Plans, Multiple Employer Trusts and Multiple Employer Welfare Arrangements Registration Form

WORD
PDF
SELF-SERVICE STORAGE:
Self-Service Storage License and Instructions

PDF

SURPLUS LINES BUSINESS ENTITY: (RETURN TO TOP)

Surplus Lines Producer for Business Entity Application         
NIPR
Broker/Producer Bond

WORD
PDF
Add Producer to Surplus Lines Agency

WORD
PDF
Filing Forms and Instructions
FILING FORMS

THIRD PARTY ADMINISTRATOR:  (RETURN TO TOP)

Instructions
 PDF
Registration Application                                        

WORD
PDF 
Bond

WORD
PDF 

TITLE: 

Summary of Fees
    WORD
PDF
New Title Agent Instructions
  WORD
PDF
Title Agent Application

WORD
PDF
Title Agent Replacement Renewal (ARF) 

WORD
PDF
New Title Agency Instructions
  WORD
PDF
Title Agency Application

WORD
PDF
Title Agency Replacement Renewal

WORD
PDF
Addition and Termination Instructions
  WORD
PDF
     Producer Addition 

WORD
PDF
     Producer Termination

WORD
PDF
Title Insurance Continuing Education
Courses and Providers (SBS) 

VIATICAL: (RETURN TO TOP)

See Life Settlement Above