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Indiana Department of Insurance

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IDOI > Important Notices, Guidelines, Updates to Law - Producer Licensing Division > Municipality Set-Aside Program > Set-Aside Program Enrollment and Notification Set-Aside Program Enrollment and Notification

Name of Municipality

Contact Information
Name and Title of Contact Person

Address of Contact Person

Contact Person Phone Number
( -

Contact Person Email Address

Enforcement Authority Information
Name of Enforcement Authority

Address of Enforcement Authority

Enforcement Authority Phone Number
( -

Enforcement Authority Email Address

Enrollment Options
Please enroll this Municipality in the Set-Aside Program

Please amend our Information

Please remove this Municipality from the Set-Aside Program

   I certify that this request has been approved by
         adoption of an ordinance by the Municipality’s
         governing body.