Change & Service Forms
Individual Producer Legal Name Change
Change Resident State
Individual Producer Inactive Status Request
Request for Medical/Military Extension
Request to Surrender License
Change of Agency Information
Pre-Need Only Insurance Producer Biennial Affirmation
Company Certification of Agent’s Sale of Pre-Need Insurance Only
Updating Information and Change Forms
Individual producers: Licensees must keep a current email address on file with the Kansas Insurance Department and must also report home address, business address and mailing address changes and name changes to the Department within 30 days of the change. Producers must use NIPR to report contact change requests. For legal name change, please use the following Individual Legal Name Change Request form.
For residence address changes that are from Kansas to another state or from another state to Kansas, please complete the following form.
An individual licensee can request to be put on Inactive status where the agent will not conduct any acts toward transacting the business of insurance. To request to be put on inactive status for no more than four years, use the following form.
An individual licensee may submit a request for an extension to complete continuing education and renewal requirements due to medical hardship or military service. To request an extension that may not exceed 180 days, use the following form.
A resident individual licensee can request to surrender his or her license in lieu of maintaining requirements for renewing a license. For information on requirements for surrendering a license in good standing, see License Surrender on the Resident Producer Licensing page.
Business Entities (agencies): For address and email changes, agencies must use NIPR contact change request. For change of DBA name and/or DRLP, agencies must electronically submit the following form. Information sent via email or by paper will not be accepted.
Pre-Need Only Insurance Producers and Company Certification
- Pre-Need Only Insurance Producer Biennial Affirmation
- Company Certification of Agent’s Sale of Pre-Need Insurance Only
Reinsurance Intermediaries – Members, Officers and Designated Employees