Forms & Instructions

Agency Affiliations & Terminations

• User Guide

Assumed Business Name

• Paper Filing

Individual Producer DBA

• Form

Business Entity

• Name Change Instructions

License Renewal

• Renewal Fees
• Request for waiver of late renewal penalty Form

License Surrender

• Form

Managing General Agent

• Instructions
• License Application
• Company Appointment
• Termination of Company Appointment
• Bond
• Contract

Motor Club

• License Instructions & Filing Paper

Name Change

• Individual Licensee Name Change Form & Instructions

Producer (includes Adjuster, Consultant and Surplus Lines)

• Testing & License Handbook
• Adjuster Affidavit Form
• Criminal Background Check Electronic Form (INA)
• Moving to Arkansas (Change from Non-resident to Resident) Form
• Emergency Temporary License Instructions

Regulatory Health Link (IPA Guide, Navigator, Certified Application Counselor, Exchange Producer)

• Additional Information on Insurance Department RHL Division

Reinsurance Intermediary

• Broker Checklist Paper
• Manager Checklist Paper

Rental Car

• Company Application Form

Surplus Lines Business Entity

• Broker/Producer Bond Form
• Filing forms and instructions (NAIC)

Self Funded

• Instructions
• Form

Third Party Administator

• Registration Instructions & Application
• Bond

Title Agency

• License Fee $250, Late Fee $100, Total if late $350

Title

• Summary of fees
• New agent Instructions
• Affidavit of Prior Title Work Experience Form
• Affidavit of Employment by Nonresident Licensee Form
• Agent replacement renewal (ARF) Form
• New agency Instructions
• Agency replacement renewal Form
• Agency Addition & Termination Instructions
• Producer addition Form
• Producer termination Form
• Continuing Education Courses & Providers (SBS)