Section 1798.17 of the California Civil Code requires the following information to be provided when collecting information from individuals to determine compliance with the group and corporate practice provisions of the law, and to establish positive identification, to match the names of the certified list provided by the Department of Child Support Services to applicants and licensees, and of responding to requests for this information made by child support agencies.
AGENCY: Department of Insurance
ADDRESS: 320 Capitol Mall, Sacramento, CA
95814-4309
TELEPHONE NUMBER: (800) 967-9331 or (916)
322-3555
TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE: Chief, Producer Licensing Bureau
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION: California Insurance Code, Chapters 5, 6, 7, 8-Part 2, Division 1
THE CONSEQUENCES, IF ANY, OF NOT PROVIDING ALL OR PART OF THE REQUESTED INFORMATION: It is mandatory that you provide all information requested. Omission of any item of requested information will result in the application being rejected as incomplete.
THE PRINCIPAL PURPOSE(S) FOR WHICH THE INFORMATION IS TO BE USED: The information requested will be used to determine qualifications for licensure or certification, to determine compliance with the group and corporate practice provisions of the law and to establish positive identification.
EACH INDIVIDUAL HAS THE RIGHT TO REVIEW FILES MAINTAINED ON THEM BY THE AGENCY, UNLESS THE INFORMATION IS CLASSIFIED AS CONFIDENTIAL UNDER SECTION 1798.3(a) OF THE CIVIL CODE.
INSTRUCTIONS FOR COMPLETING APPLICATION
RE: "LICENSE TYPE" a separate application is required for each license type requested.
RE: "APPLICANT NAME" Enter full legal name. If no middle name, enter (NMN). If any part of your legal name is an initial only, place parentheses around such initial.
RE: "ADDRESS INFORMATION" Do not enter the word "same" in any address area. Enter the appropriate address. P. O. BOX is not acceptable for a resident or business address. Business and mailing addresses are public record and are available to the public. It is the applicant's/licensee's responsibility to notify the department of any change in address.
RE: "ARE YOU A CITIZEN OF THE UNITED STATES" If no is answered, the applicant must supply a copy of both sides of the work authorization.
RE: "EXAM INFORMATION" Examinations are administered daily, Monday through Friday at 8:30 a.m. and 1:00 p.m., in Los Angeles (LA), San Diego (SD), San Francisco (SF) and Sacramento (SA). An examination is also administered twice monthly in Clovis usually the second and fourth Saturday of the month at 8:30 a.m. If you fail to appear for a scheduled examination, an additional examination fee will be required for rescheduling.
RE: "EMPLOYMENT HISTORY FOR PREVIOUS FIVE YEARS" Account for all time for the past five years. Give all employment experiences starting with your current employer working back five years. Include full and part-time work, self-employment, military service, unemployment, and full-time education.
RE: "PREVIOUS LICENSE HISTORY INFORMATION" If currently licensed as a resident in another state, upon becoming a California resident, a clearance letter from the previous state of residence is also required.
RE: "AKA/ALIAS" List previously and currently used aliases and maiden names, if any. If you are currently using an "also known as" (AKA) name which you desire to be noted on record, so state. Abbreviations of true name or "nick" names are not acceptable.
RE: "BACKGROUND QUESTIONS" If you answer yes to any of these questions, you must submit a signed statement, with your original signature summarizing the details of each event. You must also provide the additional certified documentation described with each question.
PRELICENSING EDUCATION
REQUIREMENTS: Effective 1/1/92 all new applicants must:
A) take an approved minimum
40-hour class for the fire and casualty broker-agent license exam, and/or;
B) take an approved minimum
40-hour class for the life agent license exam, and/or;
C) take an approved minimum
20-hour class for the personal lines broker-agent license exam,
D) and take an approved minimum
12-hour class on ethics and the California Insurance Code.
An applicant will be taking either 52 hours (40 and 12) or 92 hours (40 and 40 and 12) of prelicensing class hours depending on whether one or both licenses are being sought. The Personal Lines Broker-Agent applicant is required to complete 32 hours (20 and 12) of prelicensing classroom hours. Original certificates must be signed and submitted with the application.
ADDITIONAL FILING REQUIREMENTS:
The following documents are required to be submitted with the application
for the specific license types as listed:
MC
- Action Notice of Appointment** (form 447-54A) from the sponsoring insurance
company.
SL
- $50,000 bond (form 447-31) with a properly executed Power of Attorney form
attached.
SP
- $10,000 bond (form 447-32) with a properly executed Power of Attorney form
attached.
CS
- $10,000 bond (form 447-70) with a properly executed Power of Attorney form
attached.
CI
- Action Notice of Appointment** (form 447-54A) from the sponsoring insurance
company and/or Business Entity Endorsement **
(Form 411-8A) completed by
sponsoring Business Entity.
The following documents may be submitted with the initial application. Submitting these documents at a later date will not delay the issuance of your license, however, no authority to transact insurance will be granted until such time as the document has been received:
PF
- Action Notice of Appointment** (form 447-54A) from the sponsoring fraternal
benefit society or association admitted to California.
LO
- Action Notice of Appointment** (form 447-54A) from the sponsoring insurance
company and/or; Business Entity Endorsement** (form 411-8A completed by sponsoring
business entity. To be granted variable authority acceptable proof of registration
with SECO or NASD must be submitted with application and you must be appointed
by an insurer authorized for variable contracts. Failure to submit proof of
registration will result in license being issued without variable authority.
TA
-Action Notice of Appointment** (form 447-54A) from the sponsoring insurance
company.
FX/PL
- License authority is determined by what documents are submitted. To act as
a:
BROKER
- $10,000 bond (form 417-5) with properly executed Power of Attorney form attached
and/or Business Entity Endorsement **
(form 411-8A) completed by sponsoring Business Entity.
AGENT
- Action Notice of Appointment** (form 447-54A) from the sponsoring insurance
company and/or Business Entity Endorsement **
(form 411-8A) completed by sponsoring Business Entity.
SOLICITOR
-Action Notice of Solicitor** (form 417-31) completed by the sponsoring insurance
agent or broker.
To obtain insurance licensing FORMS by mail, send request to: Department of Insurance, 320 Capitol Mall, Sacramento, CA 95814, or you may phone Sacramento toll free at (800) 967-9331 or (916) 322- 3555, press 3. Forms are also available on our Web site at http://www.insurance.ca.gov.
To obtain insurance licensing information, you may phone our Sacramento office toll free at (800) 967-9331 or (916) 322-3555. You may also obtain licensing information and a complete list of licensing fees by visiting our Web site at http://www.insurance.ca.gov.
| MAIL APPLICATION WITH ATTACHMENTS AND FEES TO: | DEPARTMENT OF INSURANCE |
| P. O. BOX 1139 | |
| SACRAMENTO, CA 95812-1139 |
Form 441-9 (Rev. 01/2003)