Change & Service Forms

Updating Information and Change Forms

Maintaining your information: Licensees must keep a valid business email address on file with the Kansas Department of Insurance. All communications referencing your license status, notices, and changes are sent from the NAIC on behalf of the Kansas Department of Insurance to the business email address.  The licensee must also report changes to their resident address, business address, mailing address and name changes to the Department within 30 days of the change.  Producers must use NIPR to report contact change requests.

• NEW– Legal name changes for an individual or business entity license shall be submitted through NIPR.com. After selecting “Change Contact Information” from the licensing center, log in and select demographic.
  • Resident producer request will be required to submit supporting documentation related to the name change transaction. A business entity must first change their legal name with the Kansas Secretary of State.
  • Non-resident producer licensees must first update their license name with its home state and the name change must reflect on the Producer Database (PDB). Generally, PDB is updated the next business day after the home state has updated the name.

For residence address changes that are from Kansas to another state or from another state to Kansas, please complete the following form:

• Change Resident State

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.

• Individual Producer Inactive Status Request

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:

• Request for Medical or Military Extension

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:

• Request to Surrender License

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.

• Change of Business Entity (Agency) Information

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

• Members, Officers and Designated Employees Form