Nebraska Department of Insurance Forms

This document is an application form for obtaining a license to operate a portable electronics insurance agency in the state of Nebraska.

This application is used to apply for a limited license for a rental car agency in Nebraska.

This document is for applying for an insurance business entity license in the state of Nebraska.

This document is used for reconciling calendar year taxes in Nebraska. It helps taxpayers ensure that their tax payments and credits are accurately recorded for the previous year.

This document is used for disclosing financial information by title insurance agents and/or agencies in Nebraska. It provides transparency regarding their financial interests and potential conflicts of interest.

This document is used for managing general agents in Nebraska.

This document is used for obtaining a surety bond for public insurance adjusters in Nebraska.

This document is an application form for professional liability insurance coverage provided by the Nebraska Residual Malpractice Insurance Authority. It is specifically for occurrence-based coverage.

This form is used for issuing a certificate to a certified reinsurer in Nebraska. It verifies their status and allows them to operate in the state.

This document for the state of Nebraska is an attestation statement used to declare the truthfulness or accuracy of certain information. It is commonly used in legal or official matters.

This document is for the purposes of certifying experimental or investigational denials by physicians in Nebraska.

This document is used for certifying a treating healthcare provider to expedite the consideration of a patient's external review appeal in Nebraska.

This document is an External Review Request Form used in Nebraska for requesting a review from an external entity.

This document is used to appoint an authorized representative in the state of Nebraska.

This document is used to report a suspected fraudulent claim in the state of Nebraska. It is a referral form for authorities to investigate possible insurance fraud.

This Form is used for the issuer certification in the state of Nebraska.

This document is used for applying for a certificate of authority to operate as a motor club in the state of Nebraska.

This document is for renewing your registration for the Nebraska Purchasing Group.

This form is used for providing notice and registering a Purchasing Group in the state of Nebraska.

This form is used for applying for a Certificate of Authority as a Third Party Administrator in the state of Nebraska.

This document is used for applying for a Certificate of Registration for a Multiple Employer Welfare Arrangement (MEWA) in the state of Nebraska. MEWAs are health benefit plans that are sponsored by multiple employers for the purpose of providing health benefits to their employees.

This document is required for a motor club service company in Nebraska to provide indemnity. It ensures that the company will compensate for any damages or losses incurred by its members.

This Form is used for verifying the completion of a course in Nebraska. It is commonly used in educational institutions and professional organizations to document the fulfillment of educational requirements.

This document is an application form used by the Professional Insurance Association for individuals in Nebraska who are seeking to become a member of the organization.

This Form is used for applying for an initial or renewal license for a pre-need agent in Nebraska as required by the Burial Pre-need Sales Act.

This document is used for applying for an initial or renewal license as a pre-need seller in Nebraska under the Burial Pre-need Sales Act.

This document is used for providing information required for the change in ownership of a pre-need seller in Nebraska.

This Form is used for making personnel changes within a company operating in Nebraska. It is used to record and document any changes such as promotions, transfers, terminations, or other personnel updates.