"Adjuster Designated Home State Change Request" - New Hampshire

Adjuster Designated Home State Change Request is a legal document that was released by the New Hampshire Insurance Department - a government authority operating within New Hampshire.

Form Details:

  • Released on July 27, 2018;
  • The latest edition currently provided by the New Hampshire Insurance Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Insurance Department.

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Download "Adjuster Designated Home State Change Request" - New Hampshire

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The State of New Hampshire
Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
John Elias
Alexander K. Feldvebel
Commissioner
Deputy Commissioner
ADJUSTER DESIGNATED HOME STATE CHANGE REQUEST
Option is available only to those that reside in a state that does not require adjusters to be licensed.
Please fax to 603-271-7029 or email to producerquestions@ins.nh.gov
NH License # _________________________________________________
NPN
_________________________________________________
Name: ______________________________________________________
Change Designated Home State to :________________
Licensee Signature and Date ______________________________________________________
DHS can also be updated when processing renewal on NIPR from any non-resident state to another non-resident state.
For those selecting NH as their Designated Home State.
Any non-resident adjuster living in a state that does not license adjusters and is requesting NH as their DESIGNATED
HOME STATE MUST pass the appropriate NH Adjuster exam.
I understand the by selecting NH as my designated home state I am required to complete NH approved continuing
education for my next renewal cycle according to NH regulation 1300.
Licensee Signature and Date_________________________________________
FYI
NAIC Adjuster Reciprocity Guidelines for Designated Home State
A. Designation of Home State ‐ A state whose laws permit a nonresident adjuster to designate that state as its home state,
the home state will require the nonresident to qualify as if the person was a resident (exam requirements and CE). The
PDB and designated home state will list the record as a nonresident, designated home state.
B. Designation of Home State; CE Requirements ‐ A state that permits a nonresident adjuster to designate that state as its
home state, the home state will require and track continuing education compliance for that adjuster.
See NH INS 1300 and RSA 402-B5
July 27, 2018
The State of New Hampshire
Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
John Elias
Alexander K. Feldvebel
Commissioner
Deputy Commissioner
ADJUSTER DESIGNATED HOME STATE CHANGE REQUEST
Option is available only to those that reside in a state that does not require adjusters to be licensed.
Please fax to 603-271-7029 or email to producerquestions@ins.nh.gov
NH License # _________________________________________________
NPN
_________________________________________________
Name: ______________________________________________________
Change Designated Home State to :________________
Licensee Signature and Date ______________________________________________________
DHS can also be updated when processing renewal on NIPR from any non-resident state to another non-resident state.
For those selecting NH as their Designated Home State.
Any non-resident adjuster living in a state that does not license adjusters and is requesting NH as their DESIGNATED
HOME STATE MUST pass the appropriate NH Adjuster exam.
I understand the by selecting NH as my designated home state I am required to complete NH approved continuing
education for my next renewal cycle according to NH regulation 1300.
Licensee Signature and Date_________________________________________
FYI
NAIC Adjuster Reciprocity Guidelines for Designated Home State
A. Designation of Home State ‐ A state whose laws permit a nonresident adjuster to designate that state as its home state,
the home state will require the nonresident to qualify as if the person was a resident (exam requirements and CE). The
PDB and designated home state will list the record as a nonresident, designated home state.
B. Designation of Home State; CE Requirements ‐ A state that permits a nonresident adjuster to designate that state as its
home state, the home state will require and track continuing education compliance for that adjuster.
See NH INS 1300 and RSA 402-B5
July 27, 2018