National Insurance Producer Registry

This page provides state-specific checklists, application forms and contacts for paper resident and non-resident licensing in the State of Mississippi.

Organizational Documents

Business entities must register with the MS Secretary of State before engaging in the business of insurance before or after being licensed.

Submit Letter of Certification from domicillary state if information cannot be accessed through the NAIC producer database

Third Party Administrator (TPA), Reinsurance Intermediary, and Viatical Settlement: see instructions on state specific form

Managing General Agent (MGA); Supervising General Agent (SGA): submit list of companies appointed with and letter of appointment for each

If SGA serves as Credit LHA, then complete Mississippi form Credit Life and Credit Disability SGA Appointment form

Other Requirements

Attach a check * or money order for $200 (Adjuster, TPA) $100 (P&C, SGA, MGA Corp) or $50 (P&C, LLC, SGA, MGA Unincorporated); $25 (all LHA)
* Checks payable to Mississippi Insurance Department

In reference to question 25 on the business application, Mississippi does not require the designated/responsible licensed producer be an officer, director or partner of the business entity.

Only one license is required for an entity. Other branch locations do not need to obtain a separate license.

LHA Limited Partnership: all partners must be licensed (non-resident or resident Mississippi license)

Only one license is required for an entity, but all branch locations must be listed upon initial application.

Sign application or electronic attestation

Note: Life, Viatical, SGA, & MGA licenses expire every Dec. 31;

P&C and Adjuster expire May 31; TPAs expire on issue date.

Appointment Requirements

Insurers must file appointments electronically or use a MS appointment form (http://www.mid.state.ms.us/licensing/lhacaaform.pdf or

http://www.mid.state.ms.us/licensing/pccaaform.pdf) within 15 days of signing a contract with a producer. Appointment forms do not have to be submitted with license applications.

Other Requirements

Attach a check * or money order for $25 (P/C), $50 (Adjusters), or $20 (Life)
* Checks payable to Mississippi Insurance Department

Sign application

Organizational Documents

Submit Mississippi Secretary of State Certificate of Existence/Authority

Submit Articles of Incorporation, Partnership Agreements, Certificate of Formation for LLC

Sole Proprietorship: residents must provide documentation from the Secretary of State’s office

Third Party Administrator (TPA), Reinsurance Intermediary, and Viatical Settlement: see instructions on state specific form

Managing General Agent (MGA); Supervising General Agent (SGA): submit list of companies appointed with and letter of appointment for each

If SGA serves as Credit LHA, then complete Mississippi form Credit Life and Credit Disability SGA Appointment form

Other Requirements

Attach a check * or money order for $200 (Adjuster, TPA, Viatical Provider); $100 (P&C, SGA, MGA Corp) or $50 (P&C, LLC, SGA, MGA Unincorporated); $25 (all LHA)
* Checks payable to Mississippi Insurance Department

In reference to question 25 on the business application, Mississippi does not require the designated/responsible licensed producer be an officer, director or partner of the business entity.

Adjusting entities complete “other” block

LHA Limited Partnership: all partners must be licensed (non-resident or resident Mississippi license)

DISCLAIMER

The National Insurance Producer Registry ("NIPR") populates the State Matrix of Business Rules ("State Matrix") with information provided directly from participating state insurance departments. Participating states are encouraged to provide updated information when appropriate. NIPR does not guarantee the completeness, accuracy or adequacy of the information in the State Matrix. The information in the State Matrix does not constitute legal advice and use of this information is at user's own risk and responsibility. Any questions regarding the interpretation of the rules or the accuracy of the information should be directed to the appropriate state insurance department.

Uniform Application for Business Entities
[PDF] [Word]

Uniform Application for Individuals
[PDF] [Word]