Instructions
The FIS 0225 works best with Adobe Acrobat Reader 6.0 or higher installed on your computer. If you do not have Acrobat Reader, you can download a free copy here.

The form is divided into 4 pages to optimize viewing and minimize scrolling. Drop down boxes are provided for some fields. The form will prompt you for missing or incorrect information. Required information must be completed before you are allowed to submit the form. Failure to provide complete information could result in denial of your application or revocation of your insurance license. Accuracy of information submitted is critical.

When you have completed the form and submit it electronically we will issue a submission number. This number confirms that your form has been received. If you do not receive a credit card payment page, or upon completing the payment page a submission information page, please contact the Licensing Section at 877/999-6442. Fees duplicated due to multiple credit card submissions are non-transferable and non-refundable.

You may be required to submit via mail some additional materials. Background question information is available here. Before sending any required attachments, write your submission number in the upper right corner of each item.

We will begin processing your application once we receive any additional required materials, and/or you pass a licensing examination, if required. You may check whether your license has been issued using the Insurance Licensee Locator. 

CLICK HERE TO VIEW AND BEGIN ENTERING DATA ON THE FORM.