California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 1 - Production of Insurance › Article 12 - Self-Service Storage Agent Licensing Regulations › Section 2194.16 - Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following information is required to be filed with the
					 Commissioner by license applicants and licensees:
(a) Form 441-9 for individuals.
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NOTICE: INFORMATION COLLECTION AND
					 ACCESS
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 OWN PERSONAL
					 FILES MAINTAINED BY THE AGENCY SUBJECT TO ANY LIMITATIONS UNDER THE INFORMATION
					 PRACTICES ACT OF 1977, CIVIL CODE SECTION
					 1798.40, AND EXEMPTIONS UNDER THE
					 CALIFORNIA PUBLIC RECORDS ACT, GOVERNMENT CODE SECTION
					 6254
.
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 applicants/licensees 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: "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 (Rev. 03/2006)) from the sponsoring insurance company.
SL
- $50,000 bond (Form 447-31 (Rev. 1/2003))
					 with a properly executed Power of Attorney form attached.
SP
- $10,000 bond (Form 447-32 (Rev. 1/2003))
					 with a properly executed Power of Attorney form attached.
CS
- $10,000 bond (Form 447-70 (Rev. 12/2003))
					 with a properly executed Power of Attorney form attached.
CI
- Action Notice of Appointment (Form
					 447-54A (Rev. 03/2006)) from the sponsoring insurance company and/or Business
					 Entity Endorsement (Form 411-8A (Rev. 12/2003)) 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. If submitting an
					 online application, these documents are to be submitted after your license is
					 issued:
PF
- Action Notice of Appointment (Form
					 447-54A (Rev. 03/2006)) from the sponsoring fraternal benefit society or
					 association admitted to California.
LX
- Action Notice of Appointment (Form
					 447-54A (Rev. 03/2006)) 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
					 (Rev. 03/2006)) 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 (Rev.
					 10/2002)) with properly executed Power of Attorney form attached and/or
					 Business Entity Endorsement (Form 411-8A (Rev. 12/2003)) completed by
					 sponsoring Business Entity.
AGENT
- Action Notice of Appointment (Form
					 447-54A (Rev. 03/2006)) from the sponsoring insurance company and/or Business
					 Entity Endorsement (Form 411-8A (Rev. 12/2003)) completed by sponsoring
					 Business Entity.
SOLICITOR
- Action Notice of Solicitor (Form
					 417-31 (Rev. 7/95)) 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