Application For Adjuster Agency Licensing - Oklahoma Insurance Department Page 3
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New Applications:
1.
Please attach a letter of explanation and supporting legal documentation for background questions with a “Yes” response.
2.
Fees: License - $30.00 for single class of business, or $50.00 for two or more classes of business. $30.00 for Public (property only
class of business) + Bond in the amount of no less than $10,000.
3.
First time application fees: Non-Resident $20.00 designation for service of process fee + $20.00 application review fee. Resident
$20.00 Article review fee.
4.
First time Resident application: Submit an Oklahoma Secretary of State certified copy of the agency Articles of Incorporation
(S-Corp or C-Corp) or Articles of Organization (LLC, LC, LLP, or LP).
License Reinstatement:
1.
Please provide the previously held license number. # ________________
2.
Please remit payment in the amount of double the original renewal fee if reinstating within twenty-four (24) months of the license
expiration date. If reinstating after twenty-four (24) months, see fee schedule under “New Application” checklist.
3.
Please attach any other supporting documentation.
Name Change:
Please completed the first page only of this application, and mail it to the Oklahoma Insurance Department. If a duplicate license is
requested, complete the Duplicate License Request Form and mail it to the Oklahoma Insurance Department with a check or money order
in the amount of ½ the normal license renewal fee.
Must be signed by an officer, director, principal or
partner of the business entity.
_____________________________________________________
Signature
____________________________________________________
Month
Day
Year
____________________________________________________
Typed or Printed Name
____________________________________________________
Title
____________________________________________________
Social Security Number
____________________________________________________
Address
____________________________________________________
City
State
Zip
Adjuster Agency Rev. 01242011
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