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 ODI Services

Invoice Address Change Request
  • Complete all required fields below. Required fields are marked with an *.
  • Please submit one form per company
  • Please contact Diane Wiggins in the Fiscal Operations Division at (614)644-3266 or email diane.wiggins@insurance.ohio.gov if you have any questions regarding this form

By submitting this form, I understand and agree that ALL Ohio Department of Insurance invoices will be mailed to this address including appointments / cancellations, filing fees, certification letter fees, yearly fees (annual statement, renewal company certificate of authority), license renewal fees and any other charges requested from the Department.

 

Company Name: *
NAIC Number: 
FEIN/SSN : *
   
New Billing/Invoice Address (include "attention to" line, if applicable): *
   
  The following is for informational purposes only and will not
appear on the invoice.
Your Name: *
Phone: *
Email Address: *
   
 

The State of Ohio is an Equal Opportunity Employer

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