VOLUNTARY LICENSE SURRENDER FORM - Missouri Insurance - insurance mo 2025

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  1. Click ‘Get Form’ to open the VOLUNTARY LICENSE SURRENDER FORM in the editor.
  2. Begin by entering your name in the designated field. For example, replace '___' with your full name, such as 'Julie Rumfelt'.
  3. Next, input your producer license number in the appropriate section. Ensure accuracy by double-checking this information.
  4. Review the statement regarding the understanding of non-refundable fees and ensure you acknowledge this by reading it carefully.
  5. Enter the date of surrender in the format provided (e.g., 05/05/2011) to indicate when you are submitting this form.
  6. Sign the document in the signature field to validate your request for surrendering your license.
  7. Finally, review all entered information for accuracy before saving or exporting your completed form for submission.

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NIPR is a centralized platform for managing producer licensing data. Through NIPR, insurance producers can apply for, renew and update their licenses, making compliance and record keeping more straightforward for producers as well as the states where they operate. Visit our Licensing center for more information.
To surrender a license or delete a line of authority, submit a signed statement that includes the licensees name and license number. Submit the statement as an attachment to the email or fax number listed at the bottom of this page. Insurance licensing overview | Missouri - NIPR National Insurance Producer Registry | NIPR licensing-center state-information National Insurance Producer Registry | NIPR licensing-center state-information
Be a resident of the state. Pass the insurance licensing examination. Submit a license application and pay the $100 license fee.
Average base salary The average salary for a insurance agent is $74,368 per year in Missouri. 970 salaries taken from job postings on Indeed in the past 36 months (updated September 7, 2025).
To surrender a license or delete a line of authority, submit a signed statement that includes the licensees name and license number. Submit the statement as an attachment to the email or fax number listed at the bottom of this page.