LIC 447-7 (Rev 10 18) 2026

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Begin by entering your LICENSE NUMBER and National Producer Number (NPN) in the designated fields.
Fill in your full name as it appears on your license, including last, first, and middle names.
For businesses, provide the business entity name and complete the address fields. Ensure you include a physical address; P.O. Boxes are not acceptable.
Complete the mailing address section with either a street address or P.O. Box as needed.
Fill out the residence address, ensuring it is a physical location without a P.O. Box.
Sign the form where indicated. The signature must be from an authorized individual such as an officer or partner of the business.
Finally, review all entries for accuracy before saving your completed form for submission via mail or email.

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2007	4 Satisfied (40 Votes)

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