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Licensing Forms

NOTE: Some of these links require Adobe Acrobat© Reader, available free.

The Oregon Insurance Division no longer accepts paper applications. License applications and renewals are available through http://nipr.com/. Non-resident adjusters with no home state and Third Party Administrators renew at http://www.statebasedsystems.com/

Address/Name Change Form: 1996
Word | PDF
Affiliation/Unaffiliation of Producer, Adjuster, or Insurance Consultant: 2139
Word | PDF
Application for Written Consent: 4611
Word | PDF
Continuing-Education Credit for an Unregistered Course: 2179
Word | PDF
Continuing-Education Proctor Certification:  3128
Word | PDF
Continuing-Education Proctor Registration:  3127
Word | PDF
Criminal Records Request  4862
Word | PDF
Insurance Experience Qualification Form:  2492
Word | PDF
Life Settlement Broker Appointment/Affiliation Notice:  3025
Word |  PDF
Pre-examination Training Exemption Request:  2493
Word | PDF
Temporary Adjuster Permit Application:  3901
Word | PDF
Termination of Appointment Notice:  3003
Word | PDF