Commonly Used Licensing Forms

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

Fingerprint Background Waiver

  • 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.

Approved Fingerprint Vendors

  • 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.


CE Exemption Request Form

  • 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.

Voluntary Surrender Request Form

  • 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.

Business Entity Name Change Form

  • 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.

Business Entity Fictitious Name/DBA Filing Form

  • 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.

Incoming Funds Notification Form (EFT Payments)

  • 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).