| This page provides state-specific checklists, application forms and contacts for paper resident and non-resident licensing in the State of Mississippi. |
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| Organizational Documents |
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If an office in maintained in Mississippi, submit Mississippi Secretary of State Certificate of Existence/Authority; |
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Submit Letter of Certification from domicillary state if information cannot be accessed through the NAIC producer database |
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Third Party Administrator (TPA), Reinsurance Intermediary, and Viatical Settlement: see instructions on state specific form |
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Managing General Agent (MGA); Supervising General Agent (SGA): submit list of companies appointed with and letter of appointment for each |
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If SGA serves as Credit LHA, then complete Mississippi form Credit Life and Credit Disability SGA Appointment form |
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| Other Requirements |
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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 |
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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. |
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Adjusting entities complete “other” block
One application must be submitted for each license type |
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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. |
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Surplus and Title entities check “Property and Casualty” blocks.
Title entities check “Property and Casualty” block. |
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Sign application or electronic attestation |
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Note: Life, Viatical, SGA, & MGA licenses expire every Dec. 31;
P&C and Adjuster expire May 31; TPAs expire on issue date. |
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| Appointment Requirements |
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Insurers must file appointment form L-1 or FC-2 (licensing@mid.state.ms.us) within 15 days of signing a contract with a producer. Appointment forms do not have to be submitted with license applications. |
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| Other Requirements |
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Attach a check * or money order for $25 (P/C), $50 (Adjusters), or $20 (Life)
* Checks payable to Mississippi Insurance Department |
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Sign application |
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| Organizational Documents |
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Submit Mississippi Secretary of State Certificate of Existence/Authority |
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Submit Articles of Incorporation, Partnership Agreements, Certificate of Formation for LLC |
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Sole Proprietorship: residents must provide documentation from the Secretary of State’s office |
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Third Party Administrator (TPA), Reinsurance Intermediary, and Viatical Settlement: see instructions on state specific form |
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Managing General Agent (MGA); Supervising General Agent (SGA): submit list of companies appointed with and letter of appointment for each |
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If SGA serves as Credit LHA, then complete Mississippi form Credit Life and Credit Disability SGA Appointment form |
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| Other Requirements |
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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 |
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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. |
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Adjusting entities complete “other” block |
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LHA Limited Partnership: all partners must be licensed (non-resident or resident Mississippi license) |
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Surplus and Title entities check “Property and Casualty” blocks. |
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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.
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Uniform Application for Business Entities
[PDF] [Word] |
Uniform Application for Individuals
[PDF] [Word] |
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| Mississippi accepts the Uniform Licensing Application for resident business entities. |
| Business Checklist |
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| Mississippi Web Site |
Mail Applications to:
Mississippi Insurance Department
P.O. Box 79
Jackson, MS 39205-0079 |
Non-Resident Contacts
Business
Licensing Division
601-359-3582
Individual
Licensing Division
601-359-3569 |
Resident Contacts
Business
Licensing Division
601-359-3582
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