Information Requests & Forms

Address change

Section 31A-23a-412 of the Utah Insurance Code requires all licensees to notify the Commissioner in writing, within 30 days, of any change of address or telephone number. Producer licensees must process their own license changes electronically via SIRCON.

Correspondence from the Department is mailed to the licensee’s business mailing address on file with the department. If a PO Box is used, a street address must also be furnished.

If you are moving from one state to another, you are not able to complete your address change through SIRCON or NIPR. In accordance with Rule R590-244-11, this request must be submitted via fax, email or a PDF attachment to an email:

  • The name and title of the individual submitting the amendment,
  • The relationship to the licensee of the individual submitting the amendment,
  • The following attestation made by the individual submitting the amendment: “I hereby attest that all of the information submitted is true and correct, and that I am the individual licensee for whom the requested change is being submitted, or an authorized responsible representative of the individual or agency licensee for whom the requested change is being submitted.

Please submit the request by faxing to 385-465-6055 or emailing as a PDF attachment to email

Cancellation/surrender of license

At this time, license cancellation/surrender request are not available through SIRCON or NIPR. To cancel/surrender your license, please complete and submit Section 4 of the Change Request Form by faxing to 385-465-6055 or emailing as a PDF Attachment to email


The Department has mandated electronic filing for the addition or termination of a designee to an agency license. Electronic filing must be submitted online using SIRCON, then selecting “Maintain Firm Association.” We no longer accept the paper form previously available. Any designation/termination requests submitted to the Department by paper may be returned to the submitter without being processed.


Pursuant to UCA Rule R590-244 other than the few exceptions provided in the rule, all license applications, appointments, designations and license amendments are now required to be submitted electronically to the department using SIRCON or NIPR. The forms may be used only for those exceptions that cannot be submitted electronically via SIRCON or NIPR. All others may be rejected as incomplete and returned to the submitter without being processed, with any paid fees forfeited to the State of Utah.

The above forms are also available in our Forms Database.

Hard copy of license

The department no longer prints and mails hard copies of licenses. Licenses can be printed from SIRCON. Click on the link ‘Print a license.’ You will need the last 4 digits of the social security number and the Utah license number. Please note that there will be a $5.50 charge.

* To obtain the license number, use the Licensee Search tool on the department’s website.

Letter of certification

The department no longer issues letters of certification. Licensees can now obtain letters of certification electronically through SIRCON. To do so, go to, and click on the link entitled, “Request a Letter of Certification.”

Many state insurance departments are no longer requiring letters of certification, as most are utilizing the Producer Database (PDB) through the National Association of Insurance Commissioners (NAIC).

Letter of clearance

A Letter of Clearance is requested when a resident producer is leaving the state and wishes to be licensed in another state.

At this time, clearance letter requests are not available through SIRCON or NIPR. To obtain a Letter of Clearance, please submit the Clearance Letter Request Form by faxing to 385-465-6055 or emailing as a PDF attachment to email Upon issuing a Letter of Clearance, the Utah resident License will be inactivated.

The Clearance Letter Request Form also offers the option to convert your resident license to a non-resident license. This is done as a courtesy by the Department, free of charge. The date of expiration for the non-resident license will remain the same date your resident license would have expired. The resident license in your new resident state must be obtained within 60 days of issuance of the Utah non-resident license, or the Utah non-resident license will be terminated for failure to maintain home state license. You will be subject to reinstatement fees should you choose to reactivate the license within 1 year.

Name changes

A licensee must be licensed under the licensee’s legal name. In addition to being licensed under the legal name, a licensee may register an assumed name (alias, nickname, or DBA) with the department.

Below are instructions for changing the name on your insurance license to your legal name. Additional instructions are provided for those wanting to list an assumed name with the Department.

To change a license to your legal name (individual):

  1. Go to
  2. Select the option “Update Individual’s Name”
  3. It will be necessary to create a Producer Edge account in Sircon to continue with this process

To change a license to an organization’s legal name (agency):

  1. Complete Section 1: “Agency Change of Name” on the Change Request Form
  2. Fax this form to 385-465-6055 or email as an attachment to email

To list an assumed name (individual or agency):

  1. Complete Section 2: “Addition of an Assumed Name” on the Change Request Form
  2. Fax this form to 385-465-6055 or email as an attachment to email

If you have any further questions, please contact licensing at 801-957-9240.

Producer agreement & compensation disclosure

Beginning January 1, 2010, producers may not accept or receive any compensation from an insurer or third party administrator for the placement of a health benefit plan as per 31A-23a-501, other than a hospital confinement indemnity policy, unless prior to the customer’s purchase of the health benefit plan the producer:

  • discloses in writing to the customer that the producer will receive compensation from the insurer or third-party administrator for the placement of insurance, including the amount or type of compensation; and either
    • obtains the customer’s signed acknowledgment that the disclosure was made to them;
    • or certifies to the insurer that the disclosure was made to the customer.

Producers are welcome to use the sample Producer Agreement and Compensation Disclosure drafted by the department.