Nevada Division of Insurance

Commonly Used Licensing Forms

Below are commonly used licensing forms for applicants and licensees. Please carefully follow the associated instructions when using each form.

This form gives the Division legal authority to review your background report.
Here is a sample background waiver.
If fingerprints are required for your license type, this form must be attached to your license application, or your application cannot be processed.

This form shows all fingerprint vendors that are approved to submit fingerprints for insurance licenses to the Department of Public Safety.

Individual Update Form (name changes for individuals)

This form is used for updating your name, date of birth, social security number, national producer number or your residential address if in a new state.
Each of these changes requires certain documentation – see form for details.
Return this form to Nevada.Licensing@doi.nv.gov.

This form is for requesting exemption from continuing education.
Only Producers and Insurance Consultants can be exempted from CE; Adjusters, all Bail license types and Exchange Enrollment Facilitators must complete CE every three years prior to license renewal.
Please see NAC 683A.330 for CE exemption requirements.
Return this form to Nevada.Licensing@doi.nv.gov.

This form allows individuals and firms to surrender an entire license, or just specified lines of authority.
This document must be signed by the licensee or an authorized representative of the firm.
Return this form to Nevada.Licensing@doi.nv.gov.

Name changes resulting in a new FEIN will require a new application under the new FEIN.
Resident business entities must include the approved filing with the Nevada Secretary of State showing the new name.
Non-resident business entities must include a copy of the home state license or letter of certification showing the new name.
Return this form to Nevada.Licensing@doi.nv.gov.

This form must be completed by all business entities that intend to use a fictitious name (DBAs) for licensing purposes.
This form must include the approved DBA filing(s) from the County Clerk in the county(ies) you will use the name in.
Attach this form to your licensing application, or if already licensed, return this form to Nevada.Licensing@doi.nv.gov.

This “IFN” form is for sending an EFT payment to the Division.
To obtain the Division’s bank account and routing numbers, contact Accounting at ifn@doi.nv.gov or 775-687-0700 and ask for Accounts Receivable.
If payment is in relation to a license renewal, reference the Invoice Number from your renewal notice on the IFN form, and on the bank transmittal.
If this payment is in relation to a license application, reference the license type you are applying for (i.e. “Title Agency Application”) on the IFN form, and on the bank transmittal.
Submit the completed IFN form to Accounting at ifn@doi.nv.gov prior to transferring the funds (this ensures Accounts Receivable applies your payment to the correct invoice).