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Get FIS-0262 Name Or Address Change - Michigan

2 (5/15) Department of Insurance and Financial Services Name or Address Change for Insurance Licensees Required Information about your current license System ID / License Number (7-digit number assigned by DIFS) Name as it currently appears on your insurance license: Full Employer ID number (business entity) OR Last 4 digits of your Social Security Number Check box to indicate each item you are changing. No fees required for use of this form. Requirement: Attach document(s) as legal proof o.

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