Division of Agent and Agency Services

Agent/Adjuster Licensing Forms

For faster service, Apply online! Just click on the 'Apply For License' menu item located on the left hand side of this page and it will guide you to your license application. Click the linked form number (either the .doc or .pdf format) in order to open the forms.

Online Licensing Application
Appointment Form (DFS-H2-501.pdf ) | (DFS-H2-501.doc)
Application for Life License & Appt., U.S. Foreign/Military
(DFS-H2-376.doc) | (DFS-H2-376.pdf)
Reinsurance Intermediary Application (Firms)
(DFS-H2-1087.doc) | (DFS-H2-1087.pdf)
Reinsurance Intermediary Application (Individual) (DFS-H2-1088.doc) | (DFS-H2-1088.pdf)
Mediator Application
(DFS-H2-591.doc) | (DFS-H2-591.pdf)
Neutral Evaluator
(DFS-H2-1783.doc) | (DFS-H2-1783.pdf)

Education Systems User Manuals
TBA

Licensee User Manual in HTML format: Parts I; II
Licensee - I - Registering & Logging On(669.5 K)
Licensee - II - Now That You Have Logged On(1148 K)

Bond Forms

Public Adjuster's Bond Form
(DFS-H2-72.doc) | (DFS-H2-72.pdf)
Surplus Lines Agent's Bond Form
(DFS-H2-75.doc) | (DFS-H2-75.pdf)
Title Agency Bond
(DFS-H2-425.doc) | (DFS-H2-425.pdf)
F.S. Deposit Requirement Notification (DFS-H2-1603.pdf file) | (DFS-H2-1603.doc file)

Bail Bond Forms

Limited Surety/Professional Bail Bond Appointing Entity Form
(DFS-H2-1544.doc) | (DFS-H2-1544.pdf)
Limited Surety/Professional Bail Bond Termination of Appointment Form
(DFS-H2-1544Term.doc) | (DFS-H2-1544Term.pdf)
Statement of Surrender Form
(DFS-H2-1542.doc) | (DFS-H2-1542.pdf)
Limited Surety Agent, Professional Bail Bondsman Sworn Statement
(DFS-H2-1500.doc) | (DFS-H2-1500.pdf)
Designation or Deletion of Primary Bail Bond Agent (DFS-H2-1541.doc) | (DFS-H2-1541.pdf)
Temporary Bail Bond Agent Employment Report (DFS-H2-1543.doc) | (DFS-H2-1543.pdf)
Agent Notice of Change of Address (DFS-H2-1564.doc) |
(DFS-H2-1564.pdf)
Mandatory Employment Verification
(DFS-H2-1509.doc) | (DFS-H2-1509.pdf)
Bail Bond Rate Filing
(DFS-H2-5031.doc) | (DFS-H2-5031.pdf)
Professional Bail Bondsman Financial Statement
(DFS-H2-5041.doc) | (DFS-H2-5041.pdf)

Miscellaneous

Designation/Deletion of Primary Adjuster for Adjusting Firm
(DFS-H2-63/64.doc) | (DFS-H2-63/64.pdf)
Qualification and Verification of Experience
(DFS-H2-1428.doc) | (DFS-H2-1428.pdf)
Applicant Affirmation Statement
Designation of Supervising Agent for Customer Representatives or Limited Customer Representatives
(DFS-H2-1124.doc) | (DFS-H2-1124.pdf)
Summary Character and Credit Report
(DFS-H2-38.doc) | (DFS-H2-38.pdf)
Registration of Fraternal Benefit Society Representatives
(DFS-H2-569.doc) | (DFS-H2-569.pdf)
Affidavit of Insurance for Non-Resident Public & Independent Adjuster's
(DFS-H2-1297.doc) | (DFS-H2-1297.pdf)
Affidavit of Insurance Activity While Not Properly Appointed (DFS-H2-1105.doc) | (DFS-H2-1105.pdf)

Agent/Adjuster Educational Forms

Request for Extension of Continuing Education Compliance Period – Agents, Adjusters and Customer Representatives
(DFS-H2-460.doc) | (DFS-H2-460.pdf)
Statement of Governmental Status
(DFS-H2-1106.doc) | (DFS-H2-1106.pdf)
Application for CLU/CPCU/College Degree + Experience Status
(DFS-H2-1109.doc) | (DFS-H2-1109.pdf)
Certification of Completion
(DFS-H2-1668.doc) | (DFS-H2-1668.pdf)

For all other application forms related to any other type of license, call the Florida Department of Financial Services at (850) 413-3137. (Note: Viewing some documents in these links requires Adobe Acrobat.)

LICENSING HELPLINE: 1-850-413-3137

Florida Department of Financial Services · Division of Agent & Agency Services · 200 East Gaines St. · Tallahassee, FL 32399-0318· Legal Notices

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. Public records from the Department of Financial Services are available by request. Public Records Request