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Get Insurance Licensee Registration Cancellation Of DBA

Te and sign either the individual or business entity section of this form. Attach a certified copy of the dba filing that will serve as legal proof of the dba. Mail or deliver to the address below. There is no fee to register or change a dba for insurance professionals or entities. DO NOT send money with this form. A dba does not appear on any license, so a new license document will not be printed and mailed as proof of this form being processed. DBA Request: Add Cancel Effective Date Indivi.

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