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Appointment termination 2026
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- Click ‘Get Form’ to open the appointment termination form in the editor.
- Begin by entering the appointee information, including the agent or agency name as it appears on the TDI license and the TDI license number.
- Next, provide the insurer information. Fill in the name of the insurance company (note that group names are not acceptable) and include the NAIC or Federal tax ID number.
- Select all applicable boxes to indicate the type of appointment being terminated. This includes various license types such as General Lines Life, Accident, and Health, among others.
- Indicate the relevant statute by selecting from the provided options to ensure compliance with regulations.
- Complete the attestation section by confirming that you have attached a statement detailing the facts related to termination, including date and cause.
- Finally, fill in your email address, mailing address, city, state, ZIP code, print your name, date, and provide your signature before submitting.
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Related links
An insurer shall terminate an appointment when a previously appointed individual or agency is no longer authorized to conduct business for the insurer in Utah.Read more
Appoint, Approve/Decline, Terminate. Note: To be completed by an authorized company representative only. Companies can approve/decline applicantRead more