"Name Change Request or Dba Additions" - New Hampshire

Name Change Request or Dba Additions is a legal document that was released by the New Hampshire Insurance Department - a government authority operating within New Hampshire.

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Download "Name Change Request or Dba Additions" - New Hampshire

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The State of New Hampshire
Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
Christopher R. Nicolopoulos, Esq
Alexander K. Feldvebel
Commissioner
Deputy Commissioner
PRODUCERS----ADJUSTERS----BUSINESS ENTITIES
NAME CHANGE REQUEST or dba Additions
Please fax to 603-271-7029 or email to
producerquestions@ins.nh.gov
NH License # _______________________________________
NPN
_______________________________________
Old Name: ______________________________________________________
New Name
First Name____________________ Middle Name______________ Last Name _________________________
NEW EMAIL: ___________________________________________________
For Businesses New Name ____________________________________________________________________
DBA ADDITION ____________________________________________________________________________
Licensee Signature and Date_________________________________________
Or Signature of officer or DRLP for Entity
Name change requires proof from governmental agency such as marriage/divorce decree or court order. Please
attach to this form.
For INDIVIDUALS only: Any address changes, phone numbers or emails can be updated at no charge via
–select CONTACT CHANGE
www.nipr.com
ENTITIES - NH Secretary of State’s office will be contacted to verify name approval. You can reach them at 603-271-3246 or
their website
www.sos.nh.gov/corporate.
For those wishing to add a dba to their license- list dba requested ________________________________________________
The State of New Hampshire
Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
Christopher R. Nicolopoulos, Esq
Alexander K. Feldvebel
Commissioner
Deputy Commissioner
PRODUCERS----ADJUSTERS----BUSINESS ENTITIES
NAME CHANGE REQUEST or dba Additions
Please fax to 603-271-7029 or email to
producerquestions@ins.nh.gov
NH License # _______________________________________
NPN
_______________________________________
Old Name: ______________________________________________________
New Name
First Name____________________ Middle Name______________ Last Name _________________________
NEW EMAIL: ___________________________________________________
For Businesses New Name ____________________________________________________________________
DBA ADDITION ____________________________________________________________________________
Licensee Signature and Date_________________________________________
Or Signature of officer or DRLP for Entity
Name change requires proof from governmental agency such as marriage/divorce decree or court order. Please
attach to this form.
For INDIVIDUALS only: Any address changes, phone numbers or emails can be updated at no charge via
–select CONTACT CHANGE
www.nipr.com
ENTITIES - NH Secretary of State’s office will be contacted to verify name approval. You can reach them at 603-271-3246 or
their website
www.sos.nh.gov/corporate.
For those wishing to add a dba to their license- list dba requested ________________________________________________