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North Dakota Insurance Department
Adam Hamm, Commissioner
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communications prescription shic healthcare enforcement compliance forms special
consumers producers companies
To voluntarily cancel your North Dakota insurance producer license, complete, date and sign form SFN 53881 and fax or mail the form to the North Dakota Insurance Department.

ndlicensing@nd.gov
State Capitol, fifth floor
Dept. 401
600 E. Boulevard Ave.
Bismarck, ND 58505-0320

701.328.2440
701.328.4880 fax
800.247.0560 toll free
800.366.6888 TTY line

North Dakota Insurance Department
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
Phone 701.328.2440
Toll free 800.247.0560
Fax 701.328.4880

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