KENNY C - Nevada Division of Insurance



REQUEST FOR LETTER OF CLEARANCE

(Termination of Nevada License)

Name: ______________________________________________________________________________

SSN, Nevada License Number, or National Producer Number: ______________________________

New Resident Home State: _____________________________________________________________

New Residential Address: ________________________________________________

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________________________________________________

New Mailing Address: ________________________________________________

________________________________________________

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Preferred method of delivery: Mail Email: ____________________________________

     NRS 683A.480  Return of license to Commissioner.

      1.  All licenses issued under this Code, although issued and delivered to the licensee or his employer, shall at all times be the property of the State of Nevada. Upon any expiration, termination, suspension or revocation of the license, the licensee or other person having possession or custody of the license shall forthwith deliver it to the Commissioner.

      2.  As to any license lost, stolen or destroyed while in the possession of any such licensee or person, the Commissioner may accept in lieu of the return of the license, the affidavit of the licensee or other person responsible for or involved in the safekeeping of the license, concerning the facts of such loss, theft or destruction.

      (Added to NRS by 1971, 1657)

Enclosed Lost Misplaced Destroyed Reported stolen

I understand that upon the cancelation of my license a Letter of Clearance will be issued. If applicable, all appointments with insurers in Nevada will be terminated. I have informed all Insurance Companies and Agencies that I do business with that I am surrendering my Nevada licenses and moving to another state.

Licensee’s Signature: _______________________________________ Date: _____________

Upon the issuance of a resident license in your new home state, you may expedite the issuance of a nonresident license in Nevada by applying online through Sircon’s Compliance Express at nevada or through the National Insurance Producer Registry at .

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Department of Business and Industry

Nevada Division of Insurance

1818 E. College Pkwy, Suite 103, Carson City, Nevada 89706 Phone: (775) 687-0700 Fax: (775) 687-0797 Web: doi.

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