FIS 2328 (1/20) Department of Insurance and Financial ServicesUse a separate form for each licensee. Forms will not be held for a future date. Forms will be processed as received.Voluntary Surrender.

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How to fill out the MI FIS 2328 online

The MI FIS 2328 form is a Voluntary Surrender Request that allows insurance licensees in Michigan to surrender their licenses or specific lines of authority. This guide provides clear, step-by-step instructions to help users complete the form accurately online.

Follow the steps to fill out the MI FIS 2328 form online easily.

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
  2. Begin by entering the required information about the licensee. This includes the last name or agency name, first name, middle name or initial, suffix, Michigan System ID number, and National Producer Number.
  3. Acknowledge your decision to surrender your entire Michigan insurance license by checking the box next to the appropriate statement. You can choose from several license types, such as Producer – Individual or Agency, Insurance Adjuster, and Counselor.
  4. If you wish to surrender only specific lines of authority, check the corresponding boxes for each line you intend to surrender. Options include Life, Accident & Health, Property, Limited Lines P & C, among others.
  5. Provide the necessary attestation by signing the form. Include your name, title (if applicable), and the date signed. Make sure to type or print your name clearly.
  6. Complete the form by including your email address in the required field.
  7. Finalize your process by either saving the changes, downloading, printing, or sharing the form as needed. Once completed, submit the form via mail, fax, or email to the address provided in the instructions.

Complete your MI FIS 2328 form online today to ensure a smooth surrender of your license.

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