Download insurance licensing forms

Submit one complete and signed form per appointment. An incomplete form will be rejected and returned to appointer. To confirm that an appointment was approved please see our web site, http://insurance.ehawaii.gov/ils/app. Effective March 1, 2005, the Hawaii Insurance Division will no longer mail confirmation letters. Old forms will not be accepted after April 1, 2005.
• Form AC (4/9/09)
  Notice of Address Change
• Form APPT (2/25/09)
• Form APPTMGA (2/6/2009)
  Notice of Appointment (Insurer to MGA only)
• Form ARC
  Adding/Removing Class(es) of Insurance from a Hawaii Insurance License
• Form ARDR
  Adding/Removing a Designated Representative from the Business Entity's License
• Form BEPL (9/24/08)
  Uniform Application for Business Entity Producer License
• Form FRS (Revised 03/10/2008)
  Service Contract Provider's Financial Responsibility Statement
• Form HPL (7/15/2008)
  Hawaii Application for Individual Insurance Producer License (Resident/Non-Resident)
• Form LC (06/02/2009)
  Request for Letter of Certification / Clearance
• FORM LSB/LSP (Revised 08/03/08)
  Life Settlement Broker or Provider Application.
• Annual Life Settlements Reporting
• Form NTA
  Notice of Name Change - Adding/Removing Trade Name - Adding Assumed Name(s)
• Form SCP (03/2008)
  Registration Form - Service Contract Provider
• Form T (2/6/2009)
  Notice of Termination of Appointment
• Form VPPW (03/2008)
  Vehicle Protection Product Warrantor
• Form VS (05/29/2009)
  Voluntary Surrender of Insurance License