Get License Inactivation Request Form - Pennsylvania Department Of ...

This guide provides clear instructions on completing the License Inactivation Request Form for the Pennsylvania Department of Insurance. Users can seamlessly fill out the form online and ensure all necessary components are properly addressed.

Follow the steps to complete the License Inactivation Request Form online.

1. Press the ‘Get Form’ button to access the License Inactivation Request Form and open it in your preferred document editor.
2. In the first section, enter your name as shown on your Pennsylvania license. Make sure to fill this out clearly and accurately.
3. You must provide your signature as the licensee in the designated area to validate the request for license inactivation.
4. Next, include your Pennsylvania Insurance Department License Number in the appropriate field to ensure proper identification of your license.
5. If available, provide your National Insurance Producer Number in the specified section, which will help facilitate processing.
6. If you are submitting the request on behalf of a business entity, please enter the Tax ID Number in the relevant field.
7. For business entities, a designated licensee must sign in the required area to authorize the submission of the form.
8. Select a reason for license surrender prior to the expiration date from the provided options. If the reason is 'Other', include a brief explanation.
9. Fill in your phone number and email address to ensure the Pennsylvania Insurance Department can contact you if needed.
10. Provide the address where you would like the clearance letter to be sent, as this is required for proper routing. Be aware that clearance letters are not sent to other state insurance departments.
11. Finally, review all entries for accuracy. Once you are satisfied, save your changes, and you may choose to download, print, or share the completed form as necessary.

Complete your License Inactivation Request Form online today for a smooth submission process.