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NY.gov Portal State Agency Listing

E-mail the Insurance Licensing Bureau

This Form is to be used for questions related to insurance licensing procedures and requirements. Please provide mailing address if printed material is being requested. Do not use this form to file a complaint. Do not use this form for licensing inquiries. Consumer and licensing inquiries will NOT be responded to via this method.

Please provide your Contact Information:

Email Address:
You are a(n):
If NY Licensed, Supply License #:
First Name:
Last Name:

Your Mailing Address (optional):

Mailing Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Phone # (xxx-xxx-xxxx):
Organization (optional):


Your Questions or Request for Printed Material:

Type of Insurance Business:

(Type or copy and paste to the text-box below):

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