How to amend an insurance license

To update your contact info, submit Form AC.

Individuals may also update their info electronically on NIPR’s web site.

Contact info includes: mailing address, home address, home phone, business address, business telephone, business fax, business e-mail, business web site.

If you are a licensed producer, to obtain an appointment with an insurer or a producer so appointed by an insurer, submit Form APPT.

If you are a licensed MGA, to obtain an appointment with an insurer, submit Form APPTMGA.

Insurer must provide a statement of the duties the MGA will be performing on their behalf.

To terminate an existing appointment, submit Form T.

To add or remove a class of insurance on your license, submit Form ARC.

To add a Designated Representative on your insurance agency license, submit Form ADR.

To remove a Designated Representative on your insurance agency license, submit Form RDR.

To change your name or trade name on your insurance license, submit Form NTA.

To voluntarily surrender your license, submit Form VS.

To request a duplicate license, submit Form DLC.

To request a Letter of Certification, submit Form LC. A Letter of Certification is issued to an individual or agency who needs to submit evidence that they currently hold a resident insurance license in Hawaii.

To request a Letter of Clearance, submit Form LC. A Letter of Clearance is issued to an individual or agency who needs to submit evidence that they previously held a resident insurance license in Hawaii and it was in good standing at the time of inactivation.

All of the forms above may be submitted to the Hawaii Insurance Division – Licensing Branch via e-mail, fax or mail. No fees are required.

  • E-mail form(s) to: InsLic@dcca.hawaii.gov
  • Fax form(s) to: 808-587-6714
  • Mail forms to: Hawaii Insurance Division – Licensing Branch, 335 Merchant Street, Room 213, Honolulu, Hawaii 96813.