Service Requests, Forms and Reporting Requirements

  • SERVICE REQUEST FORM
    • The Service Request Form may be used by licensed individual or business entity Producers or Adjusters, or Bail and Recovery Agents, to request any of the following changes listed below with the IDOI Agency Services Division. Note: Additional documentation may be required. Please submit the form and any additional documentation to the contact at the top of the form. Please also allow 3-5 business days to process the request. Changes may be confirmed online at www.sircon.com/Indiana or www.nipr.com
      IMPORTANT NOTICE: Letters of Clearance are no longer issued by the Indiana Department of Insurance. A change in license status with the state (e.g., a license cancellation/voluntary surrender) may be viewed online through the National Insurance Producer Registry.
      1. Change of Legal Name - additional documentation required (see form)
      2. Add or Remove Alias/Other Name additional documentation required (see form) *For business entities only
      3. Correct Social Security Number (SSN), Federal Employer Identification Number (FEIN), or Date of Birth (DOB) - additional documentation required (see form)
      4. Change of Resident Address and/or Phone Number - PO Box will not be accepted
      5. Change of Business Address, Phone Number, and/or Fax - PO Box will not be accepted
      6. Change of Mailing Address
      7. Cancel License or Particular Line(s) of Authority
      8. Add or Remove a Designated Responsible Licensed Producer (DRLP), Owner, Officer or Director - *For business entities only
      9. Update Business E-mail and/or Personal E-mail
  • View List of All Sircon Services for helpful resources to track individual agent and agency licensing and compliance
  • Login or Create Sircon ProducerEDGE Account
  • Submit Contact Change Request through NIPR
    • Steps:
      1. Go to www.nipr.com
      2. Select the "Change" box
      3. Select the green "Start Here" box
      4. Use one of the three options to identify the Individual or Business Entity license. Check "Please read and accept the NIPR Use Agreement" and select "Next"
      5. Enter last four digits of Social Security Number and Date of Birth and select "Next"
      6. Select Name of licensee
      7. Select "Contact Change Request (Change Address, Phone or Email)" and select "Next"
      8. Select which contact information you want to change
  • Print a License
  • Reporting Administrative or Criminal Actions
  • Obtain Consent under 18 U.S.C. 1033 Federal Violent Crime Control and Law Enforcement Act
  • Request for Waiver of Pre-Licensing Education (PE) Requirement
  • Request an Extension of Continuing Education (CE) Requirement
  • For a copy of Agent Mailing Lists, email Barb Lohman at blohman@idoi.IN.gov  
  • Retiring a License
  • Transferring a License
  • Access Uniform NAIC Paper Applications