Get Individual Insurance Licensee Name Change Form - Minnesota.gov - Mn

Changing your name as an individual insurance licensee in Minnesota requires notifying the Department of Commerce through a specific form. This guide will provide step-by-step instructions to help you fill out the Individual Insurance Licensee Name Change Form effectively.

Follow the steps to complete the name change process.

1. Press the ‘Get Form’ button to obtain the Individual Insurance Licensee Name Change Form and open it in the editor.
2. Begin filling out the form by entering your license number in the designated section.
3. In the 'Former Name' field, include your last name as it appears on your current license.
4. In the 'New Name' section, provide your new last name, along with your first and middle names as applicable.
5. Indicate your license type by selecting the appropriate category from the provided options.
6. Fill in your Social Security number in the specified field to verify your identity.
7. Complete your residence address section, ensuring that your street address, city, state, and zip code are accurately noted.
8. Provide your residential telephone number, including the area code.
9. Note the date when the name change occurred to keep records updated.
10. Sign the form to certify that all information provided is accurate and complete.
11. Finally, submit the completed form along with legal documentation of your name change via fax or mail as indicated in the instructions.
12. After submission, remember to save changes, download, print, or share the form as needed for your records.

Ensure your name is updated promptly by completing and submitting your form online today.