DEPARTMENT OF INSURANCE

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DEPARTMENT OF INSURANCE

Agent Licensing Forms and Documents

Important Announcements

Unlicensed Adjuster Request - March 15, 2025 - CAT Loss - 71K

Agent Licensing Frequently Asked Questions - 103K

Examination Schedule & Testing Sites - 103K

Kentucky Education Provider Handbook - 790K

Pharmacy Benefit Manager: Frequently Asked Questions - 954K

PSI / DOI Presentation - 2M

Online Licensing Services

NIPR Non-Resident Licensing Application/Registration [

]

NIPR Resident Licensing Application/Registration [

]

NIPR Resident License Renewal Application/Registration [

]

NIPR Non-Resident Licensing Renewal Application/Registration [

]

Adjuster/Apprentice Licensing

Adjuster Designation of Home State Form - 212K

DOI Sponsoring Adjuster Form - 106K

Examination Schedule & Testing Sites - 103K

Examination Study Outline - Adjuster - 462K

Examination Study Outline - Crop Adjuster - 215K

Examination Study Outline - Workers' Comp Adjuster - 213K

Fee Schedule - 452K

Form 8301-BGC - Background Check ONLINE [

]

Form 8303 - Change of Address/Name (Form Only) - 367K

Form 8304 - Exam Retake Form - 224K

Form 8307-Request for Unlicensed Adjuster Representing and Insurer to Adjust Losses resulting from a Catastrophe - 42K

Form VS - Voluntary Surrender of License - 114K

Public Adjuster 806 KAR 9 400 - 74K

Public Adjuster Contract Checklist - 147K

Public Adjuster HB 232 - 84K

Public Adjuster Intent to Contract letter - 90K

Individual Licensing

Agent - Individual - Resident - Electronic [

]

Agent Licensing Frequently Asked Questions - 684K

Form 8301-BE Application 2021 - 261K

Form 8301-BGC - Background Check ONLINE [

]

Form 8301- Individual Application 2021 - 279K

Form 8302- Appointment 2021 - 241K

Form 8302- Termination 2021 - 222K

Form 8303- Record Correction 2021 - 367K

Form for Travel Locations - 200K

Form - Self-Service Storage Space Insurance Locations - 201K

NAIC Uniform Individual Non-Resident Application [

]

Business Entity Licensing

Form 8301- Business Entity Application 2021 - 261K

Form 8301 – TPA Administrator Applicant Certification And Attestation - 117K

Form 8302- Appointment - 241K

Form 8302-TE Termination Form - 354K

Form 8305 - Business Entity Designation or Termination of Designation Form - 23K

Form for Travel Locations - 200K

Form - Self-Service Storage Space Insurance Locations - 201K

NAIC Uniform Business Entity Non-Resident Application [

]

PBM License Application 2021 - 329K

Pharmacy Benefit Manager Annual Report

Pharmacy Benefit Manager FAQ - 264K

Pharmacy Benefit Manager Review Guide - 389K

Education Provider Information

Affidavit Restrictions and Withdrawal Information - 314K

Affidavit for Active Military Duty - Form MLW-01 - 41K

Education Course Application - 223K

Education Instructor Application - 146K

Form 304 - Affidavit For Exemption From Continuing Education - 114K

KY Commission on Proprietary Education – New Providers [

]

Kentucky Education Provider Handbook - 790K

Long-Term Care Partnership Frequently Asked Questions - 188K

NAIC Education Reciprocity Application - 155K

NAIC Uniform CE Course Approval Application - 167K

PSI / DOI Presentation - 2M

Provider Application - 107K

Laws, Administrative Regulations and Bulletins

Advisory Opinion 2004-07 Acting as Agent; Termination of Appointment (clarification of 2001-08) - 191K

Bulletin 2001-8 -Acting as Agent Exception to Appointment Termination of Appointment - 241K

Laws and Regulations

Licensing and General Information

Adjuster Designation of Home State Form - 143K

Affidavit for Active Military Duty - Form MLW-01 - 41K

Agent Licensing Frequently Asked Questions - 684K

Application for Written Consent to Engage in the Business of Insurance Pursuant to 18 U.S.C. 1033 - 129K

Certification/Clearance Request Form - 52K

FI-02 Free Choice of Agent 2020 - 91K

Fee Schedule - 452K

Form FI-03 - 60K

Form for Travel Locations - 200K

Form 8301-RV - Rental Vehicle License Supplemental Application - 85K

Form 8301-TPA - Administrator Applicant Certification and Attestation - 28K

Form 8303 - Change of Address/Name (Form Only) - 367K

Form 8304 - Exam Retake Form - 224K

Form VS - Voluntary Surrender of License - 114K

Loss of License

Loss of License - Military Active Duty - 41K

Pre-Licensing and Examination Information

Examination Study Outline - Life & Health Consultant - 185K

Examination Schedule & Testing Sites - 103K

Examination Study Outline - Crop Adjuster - 9M

Examination Study Outline - Crop Agent - 122K

Agent Licensing Frequently Asked Questions - 684K

Examination Study Outline - Adjuster - 462K

Examination Study Outline - Casualty - 130K

Examination Study Outline - Health - 43K

Examination Study Outline - Life - 38K

Examination Study Outline - Life Settlement (individuals not licensed as Life Agents) - 19K

Examination Study Outline - Personal Lines - 106K

Examination Study Outline - Property - 108K

Examination Study Outline - Travel - 84K

Examination Study Outline - Workers' Comp Adjuster - 83K

Form 8304- Exam Retake - 283K

Examination Study Outline - Property & Casualty Consultant - 225K