State Requirements

• Commissioner's Memorandum 2021-2LIC
• Commissioner's Memorandum 2021- 3LIC
• Commissioner's Memorandum 2021-6LIC

A licensee shall apply to the Department of Commerce and Consumer Affairs (”DCCA”) and the Insurance Commissioner for approval of the use or change of a trade name.

All phone and fax numbers entered on application, including authorized submitter information, must contain ten (10) digits.

Applicant must provide a valid business email address and business phone number.

Surplus Lines applicants must hold an equivalent license in their resident state.

At least one (1) Designated Responsible Licensed Producer (DRLP) must be provided on application and have an active resident or non-resident license in Hawaii.

The DRLPs provided on the Insurance Producer and Surplus Lines application must cumulatively cover the lines of authority (LOAs) on the application.

Applicant may not enter the following address as the business address:

• 6140 S Gun Club Rd, STE K6

If applicant responds "yes" to one of the background questions, please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax.

• Pharmacy Benefit Manager, Services Contract Provider, and Vehicle Protection Product Warrantor

An appointment form does not need to be submitted with the application. However, to §431:9A-114 Appointments: (a) an Insurance Producer shall not act as an agent of an insurer unless the Insurance Producer becomes an appointed agent of that insurer.  All producers will need to be appointed directly through an insurance company and appointment termination can only be submitted by an insurance company.

When applying for Surplus Lines Broker license, applicant must submit a list of individuals (names and license numbers) within the business entity who are licensed Surplus Lines Brokers via NIPR's Attachments Warehouse.  Only licensed individual Surplus Lines Brokers within your licensed business entity may transact surplus lines business.  You must provide the Licensing Branch with the names and license numbers of the individual Surplus Lines Brokers who are added or removed from your business.

Applicant must provide a valid United States business address, mailing address, and phone number.

Any licensed Insurance Producer so designated or empowered by a corporation or partnership may not be so designated or empowered by more than one corporation or partnership, except when the corporation or partnerships are affiliates of each other (must submit proof of affiliation such as organization chart or a copy of the articles of incorporation or articles of organization and identify the relevant page/portions of the document for ease of reference via NIPR's Attachments Warehouse). As used herein, a corporation or partnership is an affiliate of another corporation or partnership, if the same person directly or indirectly through one or more intermediaries, controls either corporation or partnership.

Reinsurance Intermediary Brokers, Reinsurance Intermediary Managers, and Managing General Agents must actively hold an Insurance Producer license. They can only apply for the reciprocal line of authority (LOA) they maintain on their Insurance Producer license.

Life Settlement Broker (LSB) - Must be licensed as a resident Insurance Producer with a Life line of authority in Hawaii for at least one (1) year to be eligible to apply for a Life Settlement Broker license.

Limited Lines Portable Electronic Producer (PE) – In order for the license to be issued, the business entity must submit “Form DP for PE.”  Go to https://cca.hawaii.gov/ins/producers/forms/ to find “Form DP for PE” and submit via  NIPR's Attachments Warehouse.

Pharmacy Benefit Manager (PBM) – In order for the registration to be issued, the business entity must submit “Form DP for PBM.”  Go to https://cca.hawaii.gov/ins/producers/forms/ to find “Form DP for PBM” and submit via NIPR's Attachments Warehouse.

Reinsurance Intermediary Broker (RIB) and Reinsurance Intermediary Manager (RIM) – In order for the license to be issued, the business entity must submit “Form List of RI(s).”  Go to https://cca.hawaii.gov/ins/producers/forms/ to find “Form List of RI(s)” and submit via  NIPR's Attachments Warehouse.

Service Contract Provider (SCP) – In order for the registration to be issued, the business entity must submit “Form DP for SCP” and “Form FRS."  Go to https://cca.hawaii.gov/ins/producers/forms/ to find “Form DP for SCP” and “Form FRS” and submit via  NIPR's Attachments Warehouse.

• Go to https://cca.hawaii.gov/ins/producers/forms/ and open TPA CHECKLIST form. Check appropriate boxes on the form and complete the checklist to assure completion of application filing.  A completed checklist and all documents required on the checklist must be submitted via NIPR's Attachments Warehouse.
• Third Party Administrator applicants must enter a valid United States business and mailing address.
• All applications for Third Party Administrator will defer to the state for review.

Vehicle Protection Product Warrantor (VPPW) – In order for the registration to be issued, the business entity must submit “Form DP for VPPW” and “Form FSS." Go to https://cca.hawaii.gov/ins/producers/forms/ to find “Form DP for VPPW” and “Form FSS” and submit via NIPR's Attachments Warehouse.