DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

Contribute to the Team Eastern Kentucky Flood Relief Fund at TeamEKYFloodReliefFund.ky.gov

DEPARTMENT OF INSURANCE

Agent Licensing Forms and Documents

Important Announcements

Agent Licensing Frequently Asked Questions - 684K

Examination Schedule & Testing Sites - 122K

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 - 122K

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

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 - 122K

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

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