Protecting the Insurance-Buying Public by Licensing Competent and Trustworthy Individuals and Entities and Expeditiously Investigating Alleged Violations of the Florida Insurance Code

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Licensure & Compliance

Forms

To access forms on this page, click the linked form number, either the a Word .doc or Acrobat .pdf format, to open.

Agent and Adjuster Licensing Forms

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• Appointment Form (DFS-H2-501.pdf ) | (DFS-H2-501.doc)
• Application for Life License & Appt., U.S. Foreign/Military (DFS-H2-376.doc) | (DFS-H2-376.pdf)
• Reinsurance Intermediary Application (Firms) (DFS-H2-1087.doc) | (DFS-H2-1087.pdf)
• Reinsurance Intermediary Application (Individual) (DFS-H2-1088.doc) | (DFS-H2-1088.pdf)
• Mediator Application (DFS-H2-591.doc) | (DFS-H2-591.pdf)
• Neutral Evaluator Application (DFS-H2-1783.doc) | (DFS-H2-1783.pdf)
• Public Adjuster Apprentice Employment Report (DFS-H2-1979.doc) | (DFS-H2-1979.pdf)

Bond Forms

• Public Adjuster's Bond Form (DFS-H2-72.doc) | (DFS-H2-72.pdf)
• Surplus Lines Agent's Bond Form (DFS-H2-75.doc) | (DFS-H2-75.pdf)
• Title Agency Bond (DFS-H2-425.doc) | (DFS-H2-425.pdf)
• F.S. Deposit Requirement Notification (DFS-H2-1603.pdf file)  | (DFS-H2-1603.doc file)

Bail Bond Forms

• Temporary Bail Bond Agent Employment Report (DFS-H2-1543.doc) | (DFS-H2-1543.pdf)
• Limited Surety/Professional Bail Bond Termination of Appointment Form (DFS-H2-1544Term.doc) | (DFS-H2-1544Term.pdf)
• Statement of Surrender Form (DFS-H2-1542.doc) | (DFS-H2-1542.pdf)
• Limited Surety Agent, Professional Bail Bondsman Sworn Statement (DFS-H2-1500.doc) | (DFS-H2-1500.pdf)
• Designation or Deletion of Primary Bail Bond Agent (DFS-H2-1541.doc) | (DFS-H2-1541.pdf)
• Limited Surety/Professional Bail Bond Appointing Entity Form (DFS-H2-1544.doc) | (DFS-H2-1544.pdf)
• Agent Notice of Change of Address (DFS-H2-1564.doc) | (DFS-H2-1564.pdf)
• Mandatory Employment Verification (DFS-H2-1509.doc) | (DFS-H2-1509.pdf)
• Bail Bond Rate Filing (DFS-H2-5031.doc) | (DFS-H2-5031.pdf)
• Professional Bail Bondsman Financial Statement (DFS-H2-5041.doc) | (DFS-H2-5041.pdf)

Senior Suitability Forms

• Annuity Suitability Questionnaire (DFS-H1-1980.doc) | (DFS-H1-1980.pdf)
• Disclosure and Comparison of Annuity Contracts (DFS-H1-1981.doc) | (DFS-H1-1981.pdf)

Miscellaneous  Forms

• Designation/Deletion of Primary Adjuster for Adjusting Firm (DFS-H2-63/64.doc) | (DFS-H2-63/64.pdf)
• Qualification and Verification of Experience (DFS-H2-1428.doc) | (DFS-H2-1428.pdf)
• Applicant Affirmation Statement
• Designation of Supervising Agent for Customer Representatives or Limited Customer Representatives (DFS-H2-1124.doc) | (DFS-H2-1124.pdf)
• Summary Character and Credit Report (DFS-H2-38.doc) | (DFS-H2-38.pdf)
• Registration of Fraternal Benefit Society Representatives (DFS-H2-569.doc) | (DFS-H2-569.pdf)
• Affidavit of Insurance for Non-Resident Public & Independent Adjuster's (DFS-H2-1297.doc) | (DFS-H2-1297.pdf)
• Affidavit of Insurance Activity While Not Properly Appointed (DFS-H2-1105.doc) | (DFS-H2-1105.pdf)
• Cancellation Notice for Insurance Agency licensure (DFS-H2-1997.doc) | (DFS-H2-1997.pdf)

Agent/Adjuster Educational Forms

• Request for Extension of Continuing Education Compliance Period - Agents and Customer Representatives (DFS-H2-460.doc) | (DFS-H2-460.pdf)
• Statement of Governmental Status (DFS-H2-1106.doc) | (DFS-H2-1106.pdf)
• Application for CLU/CPCU/College Degree + Experience Status (DFS-H2-1109.doc) | (DFS-H2-1109.pdf)
• Certification of Completion (DFS-H2-1668.doc) | (DFS-H2-1668.pdf)

Other Forms

For all other application forms related to any other type of license, call the Florida Department of Financial Services at (850) 413-3137.