"Appointment / Terminaiton Form" - Nebraska

Appointment / Terminaiton Form is a legal document that was released by the Nebraska Department of Insurance - a government authority operating within Nebraska.

Form Details:

  • Released on January 1, 2019;
  • The latest edition currently provided by the Nebraska Department of Insurance;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Insurance.

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Download "Appointment / Terminaiton Form" - Nebraska

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NEBRASKA DEPARTMENT OF INSURANCE
APPOINTMENT / TERMINAITON FORM
Appoint
Submitted by: ________________________________________________________
Terminate
Submitter's email: ____________________________________________________
Producer Name
NPN
License Type
Line(s) of authority
Company NAIC Number
Fee
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Total
0
For Appointment fees please see the Nebraska Retalitory Appointment Fee schedule.
The fee for appointment terminations is $3.00.
Fees can be be paid online at:
http://ne.gov/go/nedeptofinsurance
or by mailing a check to the Nebraska Department of Insurance
at:
Nebraska Department of Insurance
PO Box 82089
Lincoln, NE 68501-2089
doi.licensing@nebraska.gov
NEBRASKA DEPARTMENT OF INSURANCE
APPOINTMENT / TERMINAITON FORM
Appoint
Submitted by: ________________________________________________________
Terminate
Submitter's email: ____________________________________________________
Producer Name
NPN
License Type
Line(s) of authority
Company NAIC Number
Fee
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Temporary Producer
Total
0
For Appointment fees please see the Nebraska Retalitory Appointment Fee schedule.
The fee for appointment terminations is $3.00.
Fees can be be paid online at:
http://ne.gov/go/nedeptofinsurance
or by mailing a check to the Nebraska Department of Insurance
at:
Nebraska Department of Insurance
PO Box 82089
Lincoln, NE 68501-2089
doi.licensing@nebraska.gov
Nebraska Retaliatory Appointment Fees
State
Fees
State
Fees
Alabama
$10
North Dakota
$10
Alaska
$8
Ohio
$15
Arizona
$8
Oklahoma
$30
Arkansas
$60
Oregon
$8
California
$8
Pennsylvania
$15
Colorado
$8
Rhode Island
$8
Connecticut
$10
South Carolina
$20
Delaware
$8
South Dakota
$20
DC
$25
Tennessee
$8
Florida
$30
Texas
$10
Georgia
$14
Utah
$8
Hawaii
$8
Vermont
$30
Idaho
$8
Virginia
$10
Illinois
$8
Washington
$10
Indiana
$8
West Virginia
$25
Iowa
$8
Wisconsin
$30
Kansas
$8
Wyoming
$15
Kentucky
$25
Virgin Islands
$8
Louisiana
$20
Guam
$8
Maine
$30
Puerto Rico
$8
Maryland
$8
Massachusetts
$75
Michigan
$8
Minnesota
$8
Mississippi
$25
Missouri
$8
Montana
$8
Nebraska
$8
Nevada
$15
New Hampshire
$8
New Jersey
$25
New Mexico
$20
New York
$8
North Carolina
$10
Rev 1/2019
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