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Fis 2328-2026

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  1. Click ‘Get Form’ to open the fis 2328 in the editor.
  2. Begin by entering the required information about the licensee. Fill in the last name or agency name, first name, middle name or initial, suffix, Michigan System ID number, and National Producer Number.
  3. Indicate your understanding of voluntarily surrendering your entire Michigan insurance license by checking the appropriate box.
  4. Select the type of license you wish to surrender from the provided options. Ensure you check all relevant boxes for Producer, Counselor, Solicitor, etc.
  5. If you wish to maintain your Michigan insurance producer license but surrender specific lines of authority, check the corresponding boxes for Life, Accident & Health, Property, etc.
  6. Complete the attestation section by signing and providing your printed name and title if applicable. Don’t forget to include your email address and date signed.
  7. Once completed, submit the form via mail, fax, or email as instructed at the bottom of the document.

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