Fillable DIVISION OF INSURANCE (South Dakota DLR)

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DIVISION OF INSURANCE (South Dakota DLR)

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South Dakota Department of Labor & Regulation (DLRA) aim to promote economic opportunity and financial security in the South Dakota. They support individuals and businesses through expert services, employment solutions and business practices.

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Thank you for the notification that a business entity that is currently licensed in South Dakota
has undergone a name
change or merge. The materials listed below must be submitted to this
office to complete the transfer of licensing records to the new name (your license number will
not be affected by the name change):
1) Copy of amended Certificate of Incorporation* indicating name change.
or
Copy of amended Certificate of Authority* indicating name change.
*Certificates can be secured through the SD Secretary of States Office (ph. 605.773.3537).
2) Return the original firm/corporation license.
3) This form with the following information completed:
Former name and address: Changed to:
_____________________________________ _________________________________________
_____________________________________ _________________________________________
_____________________________________ _________________________________________
Phone # __________________________ Contact Person: ________________________________
FEIN # __________________________ Email Address: ________________________________
List all agents, currently holding licenses in South Dakota authorized under this license:
NAME: SS# NAME: SS#
________________________ ______________ _______________________ _____________
________________________ ______________ _______________________ _____________
________________________ ______________ _______________________ _____________
To obtain a copy of the updated license reflecting the name change:
► Print through the Sircon (Vertafore) Producer portal link available in the "Online Services"
section on the Division's producer information webpage. Please allow one week for
our office to process the update prior to placing the license print request.
or
► Submit a $10.00 fee to the Division of Insurance.
Thank you,
Producer Licensing
SD Division of Insurance
SOUTH DAKOTA DEPARTMENT OF LABOR AND REGULATION
DIVISION OF INSURANCE
124 S. EUCLID AVE., 2ND FLOOR PIERRE, SOUTH DAKOTA 57501
Tel. 605.773.3513 Fax: 605.773.5369 dlr.sd.gov/insurance
INFORMATION UPDATE FOR CORPORATION NAME CHANGE
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DIVISION OF INSURANCE (South Dakota DLR)

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Completed 21 August 2020

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