Welcome to Ohio Department of Insurance

Skip Navigation

Please Note: You are viewing the non-styled version of Ohio Department of Insurance. Either your browser does not support Cascading Style Sheets (CSS) or it is disabled. We suggest upgrading your browser to the latest version of your favorite Internet browser.

Ohio.gov

Ohio Department of Insurance Agent / Agency Services

Agent Address Change Request
  • Complete all required fields below. Required fields are marked with an *.
  • Name changes must be mailed directly to the Department along with proof of the name change. For example a marriage certificate, divorce decree or copy of a drivers license.
  • Click for Printable Version of this Form
  • *SSN: 
    *Birth Date:  (MM/DD/YYYY)
    *Last Name: 
    *First Name: 
     
    50 W. Town Street, Third Floor - Suite 300   Columbus, Ohio   43215
    General Info: 614-644-2658  |  Consumer Hotline: 800-686-1526  |  Fraud Hotline: 800-686-1527  |  OSHIIP Hotline: 800-686-1578