Change of Agency Status

Changes to the information contained in the original application for an insurance agency license should be provided on Form AG11, Change of Agency Status (pdf). Use this form to report termination of agency contracts with insurance companies; change of agency address; change of owners, officers, directors, partners, or the licensed agent designated to be responsible for the agency’s compliance with the insurance laws, rules, and regulations of this state; and changes of licensed agency personnel.

Information regarding agent additions and terminations must be reported within thirty (30) working days. Failure to do so subjects the agency to a penalty of $10 per day for each working day the required information is late subject to a maximum of $50 per person per licensing year.

For changes involving ownership, agency name, or agency tax identification number, contact the Kansas Insurance Department for instructions.