Prelicensing Continuing Education Forms

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AGENTS & BROKERS: prelicensing continuing education forms

Education Forms - The following Prelicensing/Continuing Education Forms are now available in Adobe's Portable Document Format (PDF). To view and complete these pdf forms on your browser you must have Adobe Acrobat Reader 3.0 or higher on your computer. A free copy of the Adobe Acrobat Reader can be downloaded from the Adobe Web site. Additional forms will be added or revised periodically, so keep checking back. Prelicensing/Continuing Education Forms Producer Licensing Bureau Education Forms Alphabetical Listing

Prelicensing/Continuing Education Forms in pdf format (The following PDF forms are all Interactive)

Form Number PDF Format	Form Name
LIC 001B	Bail Course Application/Renewal Application
LIC 446-2	Provider Certification/Renewal Application
LIC 446-3	Course Approval Application
LIC 446-4	Instructor Qualification Form
LIC 446-5	Course Attendance Record and Verification Form
LIC 446-8	Prelicensing Education Requirements
LIC 446-9	California Long-Term Care, California Partnership, Annuities, and Workers' Compensation Continuing Education Requirements
LIC 446-12	Class Presentation Schedule
LIC 446-13	Provider Roster
LIC 446-32	Stipulation to Maintain Records Outside of California
LIC 446-40	Out-of-State Provider Jurisdiction Agreement
LIC 446-42	Education Provider - Change of Address
Information & Filing Form	NAIC Uniform Continuing Education Reciprocity (CER) Course Filing Form
Provider Summary	Parties Interested in the Prelicensing & Continuing Education Program Provider Summary Notice

Producer Licensing Bureau Education Forms-Alphabetical Listing in pdf format (The following PDF forms now interactive)

Form Name	Form Number PDF Format
Bail Course Approval/Renewal Application	LIC 001B
California Tax Qualified Long Term Care, California Partnership, Workers Compensation Continuing Education Requirements	LIC 446-9
Class Presentation Schedule	LIC 446-12
Course Approval Application	LIC 446-3
Course Attendance Record and Verification Form	LIC 446-5
Education Provider - Change of Address	LIC 446-42
Instructor Qualification Form	LIC 446-4
Midwest Zone Continuing Education Reciprocity Project	Information Filing Form
Out-of-State Provider Jurisdiction Agreement	LIC 446-40
Parties Interested in the prelicensing & Continuing Education Program Provider Summary Notice	Provider Summary
Prelicensing Education Requirements	LIC 446-8
Provider Certification/Renewal Application	LIC 446-2
Provider Roster	LIC 446-13
Stipulation to Maintain Records Outside of California	LIC 446-32

Frequently Asked Questions If you need further assistance, please call CDI's Producer Licensing Bureau's Education Unit at (916) 492-3064. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the California Department of Insurance.