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Click ‘Get Form’ to open it in the editor.
Begin by selecting the appropriate license type: Resident or Non-Resident. Fill in your Home State and License Number if applicable.
Complete the Demographic Information section, including your Social Security Number, National Producer Number (if assigned), and personal details such as name, date of birth, and address.
In the Agency or Business Entity Affiliations section, list any insurance agency affiliations along with their FEIN and NPN numbers.
Provide a detailed Employment History for the past five years, including all relevant positions held.
Carefully read and answer all questions in the Background Information section. Attach necessary documents if you answer 'Yes' to any questions.
Finally, review the Applicant’s Certification and Attestation section. Ensure all information is accurate before signing and dating the application.

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Do states have to adopt NAIC model laws?

Formed in 1871, the NAIC is a voluntary association of insurance commissioners from each of the fifty states, the District of Columbia, and the United States territories. The NAICs stated goals are to ensure the solvency of insurers, protect policyholders, and preserve state regulation as well as the NAIC itself.

Does the NAIC encourage uniformity in state insurance laws and regulations?

While the NAIC is made up of each states insurance commissioners, it remains a non-governmental organization. Its main purpose is to protect and benefit insurance consumers by promoting uniformity of insurance laws and state regulations.

What is uniform application?

The Uniform Application (UA) is a standard licensure application used by many state medical boards. The UA serves as the core application for medical licensure without replacing unique state-level requirements and eliminates the redundancy of entering information when applying for licensure in multiple states.