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To change the license's business name, complete the "Application to Change Business Name or Address" (form 13L-4). Insurance Producer, Adjuster, or Limited Representative License Request Duplicate License Free license prints are available online for printing through.Only a properly completed request for modification (RFM) will be accepted. To request a name change, complete the Name Change form and send with payment to the addresses provided on the form. See page 2 to determine if you are completing the correct application. Enter your designee's full name and mailing address. If you check box (2) or (3), complete Section 2. If you check box (2) or (3), complete Section 2. ADDING AN OWNER'S NAME OR CHANGING AN OWNER'S NAME: • Complete an application for corrected title in full (use form VSD 190). 2.4.1 Clinical Trial Application-Amendment (CTA-A): Clinical; 2.4.