Voluntary Surrender Request Form (FIS 2328): Fill out & sign online

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Click ‘Get Form’ to open the Voluntary Surrender Request Form (FIS 2328) in our editor.
Begin by entering your required information in the designated fields. Fill in your last name, first name, middle name or initial, and suffix if applicable. Ensure you also include your Michigan System ID and National Producer Number.
Indicate your understanding of voluntarily surrendering your entire Michigan insurance license by checking the appropriate box. Select the license type(s) you wish to surrender from the provided options.
If you intend to maintain your Michigan insurance producer license but surrender specific lines of authority, check the corresponding box and select the lines you wish to surrender.
Complete the attestation section by signing and dating the form. Include your email address and title if representing a business entity.
Once completed, submit the form via mail, fax, or email as instructed at the bottom of the document.

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