"Name Change Request Form" - Oklahoma

Name Change Request Form is a legal document that was released by the Oklahoma Insurance Department - a government authority operating within Oklahoma.

Form Details:

  • Released on January 12, 2016;
  • The latest edition currently provided by the Oklahoma 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 Oklahoma Insurance Department.

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Download "Name Change Request Form" - Oklahoma

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(01/12/2016)
OKLAHOMA INSURANCE DEPARTMENT
Attn: Bail Bond Division
th
3625 NW 56
, Suite 100, Oklahoma City, OK 73112-4511
(405) 521-6610 – Fax: (405) 522-6905 – Toll Free In-State 800-522-0071
Name Change Request
(Please Print or Type)
Date
Name
Oklahoma Bail Bondsman License#
Business email address (Required)
NOTE: To request a duplicate pocket photo license, mark the line below and submit the Twenty Five Dollar ($25.00) fee.
Allow 5 business days for the requested change to be processed. You may view and/ or print a new license certificate from
our website,
www.bailbonds.oid.ok.gov.
NAME CHANGE
to
Effective Date of Change
(must be supported by documentation)
Documents accepted as proof of name change:
Marriage Certificate
Court Order
Divorce Decree
You are required to update your name information with the Oklahoma Insurance Department within fi v e
(5) days after your legal name change. Pursuant to 59 O.S. §1310(A)(23), a licensee must notify the
Commissioner of a change of legal name, residence address, business address, mailing address, e-mail address,
or telephone number within five (5) days after a change is made.
______ I request a duplicate pocket photo license.
Enclosed is check or money order, number ____________________ in the amount of Twenty Five Dollars ($25.00).
Submit your request by email to
BailLicensing@oid.ok.gov
or by fax to 405-522-6905. If you requested a
duplicate photo pocket license, mail your request and payment to the above address.
I hereby certify that, under penalty of perjury, all of the information submitted in this name change request
form is true and complete. I am aware that submitting false information or omitting pertinent or material
information in connection with this form may subject my insurance license to administrative action by the
Oklahoma Insurance Department, including but not limited to civil fines.
SIGNATURE
(01/12/2016)
OKLAHOMA INSURANCE DEPARTMENT
Attn: Bail Bond Division
th
3625 NW 56
, Suite 100, Oklahoma City, OK 73112-4511
(405) 521-6610 – Fax: (405) 522-6905 – Toll Free In-State 800-522-0071
Name Change Request
(Please Print or Type)
Date
Name
Oklahoma Bail Bondsman License#
Business email address (Required)
NOTE: To request a duplicate pocket photo license, mark the line below and submit the Twenty Five Dollar ($25.00) fee.
Allow 5 business days for the requested change to be processed. You may view and/ or print a new license certificate from
our website,
www.bailbonds.oid.ok.gov.
NAME CHANGE
to
Effective Date of Change
(must be supported by documentation)
Documents accepted as proof of name change:
Marriage Certificate
Court Order
Divorce Decree
You are required to update your name information with the Oklahoma Insurance Department within fi v e
(5) days after your legal name change. Pursuant to 59 O.S. §1310(A)(23), a licensee must notify the
Commissioner of a change of legal name, residence address, business address, mailing address, e-mail address,
or telephone number within five (5) days after a change is made.
______ I request a duplicate pocket photo license.
Enclosed is check or money order, number ____________________ in the amount of Twenty Five Dollars ($25.00).
Submit your request by email to
BailLicensing@oid.ok.gov
or by fax to 405-522-6905. If you requested a
duplicate photo pocket license, mail your request and payment to the above address.
I hereby certify that, under penalty of perjury, all of the information submitted in this name change request
form is true and complete. I am aware that submitting false information or omitting pertinent or material
information in connection with this form may subject my insurance license to administrative action by the
Oklahoma Insurance Department, including but not limited to civil fines.
SIGNATURE