FIS 0506 (09 09) Office of Financial and Insurance Regulation Page - michigan-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Applicant’s Name and Firm’s Fiscal Year End. Ensure that all details are accurate to avoid processing delays.
3. Fill in the Applicant’s Home Office Address, including City, State, ZIP Code, and contact information such as E-Mail Address and Telephone Number.
4. Indicate the Type of Business Entity by checking the appropriate box. If applicable, attach additional pages with required partner or officer details.
5. Answer the questions regarding any past convictions or license issues truthfully. Attach complete details if you answer 'yes' to any question.
6. Review your application for completeness. Incomplete applications may be returned unprocessed. Once satisfied, save your document.
7. Submit your completed application by mailing it to the provided address or using our platform for electronic submission if available.

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