Change & Service Forms

Updating Information and Change Forms

Individual producers: Licensees must keep a current email address on file with the Kansas Department of Insurance 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:

• Individual Producer Legal Name Change

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