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Reinsurance Intermediary Broker / Manager

IC 27-6-9 and 760 IAC 1-51

To allow sufficient time for processing the application with attachments is requested to be submitted thirty (30) days prior to expiration.  Once the application and materials are approved, a new license will be mailed to the Reinsurance Intermediary.

Please refer to the application for further instructions.

Reinsurance Intermediary Application    Broker Manager

Biographical Affidavit

Broker Contract Checklist,

Manager Contract Checklist

Annual Reinsurance Premium Managed Certification

Please submit the application documents to:

Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 103
Indianapolis, IN  46204-2787