P. O. Box 320279 I Jackson MS 39232
Ph.: (601) 354-6161 I (800) 880-6161 I Fax: (601) 354-6715 I www.msboc.us
Residential License Renewal Form
Residential licenses must be renewed annually. You may renew online at www.msboc.us or return this form with a check or money order made payable to MSBOC
in the amount of $100 before the expiration date indicated on your license. If your license has expired, the fee is $110. Fees are non-refundable. If your license has
been expired for more than 180 days, you must submit a new application. To obtain a new application go to www.msboc.us.
License #: __________________________ Current Status (check one): □ Active □ Inactive *To change status from active to inactive or vice versa, you must submit
a written request and $25 processing fee. License must be renewed annually and renewal fee paid annually even while on inactive status. Proof of general
liability insurance coverage is NOT required while on inactive status. *Contractor is not allowed to submit bids, enter into contracts or perform work while on inactive
status. For additional information about transferring to INACTIVE status, please visit www.msboc.us or contact MSBOC at (800) 880-6161.
Name:___________________________________________________ Address: __________________________________________________________________
City / State / Zip: _____________________________________________________________________________________________________________________
E-mail:___________________________________________________ Telephone #: (______) ____________________ Fax #:(_____) ______________________
Check or Money Order Number: _______________________
THE FOLLOWING DOCUMENTATION IS REQUIRED. FAILURE TO REMIT THE FOLLOWING WILL RESULT IN RENEWAL BEING RETURNED.
General Liability Insurance certificate of coverage (The name listed as insured on the certificate of coverage must match the name listed on your license
and MSBOC must be listed on the certificate, as certificate holder to be notified in the event of cancellation of coverage or it will be returned. .
Proof of Good Standing with Mississippi Secretary of State (Proof may be printed from website: www.sos.ms.gov) *Requirement does not apply to
individual/sole proprietor.
Workers Compensation Insurance certificate of coverage (if required by law).
Proof of each qualifier’s 2 hours of Continuing Education. *Requirement does not apply if license issued before July 1, 2015 or while on INACTIVE status.
The list of approved courses is on our website under Continuing Education.
Signature below is required and indicates all information is correct and there have been no changes in (a) qualifying party, (b) ownership, (c) name, or (d) address.
* If there have been any changes in (a) qualifying party, (b) ownership, (c) name, or (d) address please provide written details on company letterhead.
I (owner/officer/qualifying party) ________________________________________________________________certify the information provided is true and accurate.
Printed name/Title: __________________________________________________________________________ Date: ____________________________________
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