Producer Licensing Forms in Alphabetical Order

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AGENTS & BROKERS: Producer Licensing Bureau Forms Alphabetical by Title

The following producer licensing forms are listed in "Alphabetical Order." These forms are available in Adobe's Portable Document Format (PDF). To view and complete these pdf forms on your browser you must have Adobe Acrobat Reader on your computer. A free copy of the Adobe Acrobat Reader can be downloaded from the Free Document Readers website. Additionally, forms may be revised periodically or new forms may be added, so keep checking back.

Interactive Forms: Additionally, the Producer Licensing Bureau converted all of its forms to be interactive. An interactive form allows users of the CDI Website to type the information onto the application while on their computer before printing the form.

Producer Licensing Bureau Forms Alphabetical by Title

Form Title	Download PDF Form Here
Action Notice of Appointment To submit appointments electronically contact the National Insurance Producer Registry (NIPR) and its authorized business partners for a list of approved partners.	LIC 447-54A
Action Notice of Solicitor	LIC 417-31
Action Notice of Termination To submit terminations electronically contact the National Insurance Producer Registry (NIPR) and its authorized business partners for a list of approved partners.	LIC 447-54T
Action Notice Statement (Bail Agent or Permittee)	LIC 438
Action Notice Bail Agent	LIC 437-23
Adjuster/Public Adjuster Individual License Application	LIC 41A
Adjuster/Public Adjuster Organization License Application	LIC 42A
Adjuster/Public Adjuster Personal Identification Information	LIC 31A-9
Administrator Certification (RA) Application	LIC 441-12
Agent Notice of Termination (self)	LIC 447-69
Annual Certification of Coverage for Limited Liability Companies	LIC CC1B
Application for Public Insurance Adjuster Authorization	LIC 0100A
Authorization to Maintain Trust Account Records at a Secondary Office Application	LIC L 450
Background Information Change Disclosure Form	LIC 2557B
Bail Agent - Change of Corporate Stockholder, Officer, or Director	LIC 437-25
Bail Corporate License Application	LIC 431-2
Bail Course Approval/Renewal Application	LIC 001B
Bail Identification Card Request Form	LIC 268-C
Bail License Application	LIC 431-1
Bail License Renewal	LIC 431-1B
Bond of Bail Agent	LIC 437-9
Bond of Bail Permittee	LIC 437-10
Bond of Bail Solicitor	LIC 437-11
Bond of Cargo Shippers Agent	LIC 447-70
Bond of Insurance Broker (Property broker and/or Casualty broker or Personal Lines broker)	LIC 417-5
Bond of Insurance Adjuster	LIC 31A-14
Bond of Public Insurance Adjuster	LIC 94A
Bond of Special Lines' Surplus Lines Broker	LIC 447-32
Bond of Surplus Lines Broker	LIC 447-31
Branch Office Certificate Application	LIC 31A-13
Business Entity Disclosure	LIC BED-1
Business Entity Endorsement Business Entity Endorsement and Termination Online Service (This service is available for most but not all license types)	LIC 411-8A
Business Entity Endorsement Termination Business Entity Endorsement and Termination Online Service (This service is available for most but not all license types)	LIC 411-8T
Business Entity License Application (Resident & Non-Resident) Business Entity Online License Application (This service is available only for Property Broker-Agent, Casualty Broker-Agent, Life-Only Agent and Accident and Health Agent license types.)	LIC 441-11
Business Entity Supplemental Application	LIC 441-11A
California Tax Qualified Long-Term Care, California Partnership & Workers Compensation Continuing Education Requirements	LIC 446-9
Certificate of Convenience - Supplementary Application for Executor, Administrator, Widow, or Heir	LIC 411-10
Certification of Coverage for Limited Liability Companies	LIC CC1
Certificate to Sell Securities as Agent	LIC 441-1
Change of Address Change your Address Online (If you are changing states, please use Form LIC 447-7)	LIC 447-7
Class Presentation Schedule	LIC 446-12
Copartnership - Application for Registration	LIC 421-4
Credit Insurance Agent Annual Certification of Endorsee Training and List of Endorsees	LIC CI 40
Credit Insurance Agent Employee's Affidavit of Training and Knowledge	LIC CI 50
Credit Insurance Agent The Annual Training Material Submission Form	LIC CI 10
Credit Insurance Agent Notice of Appointment	LIC CI 20
Credit Insurance Agent The Outline for Required Training Elements	LIC CI 30
Education Provider - Change of Address	LIC 446-42
Electronic Filing Exemption of Insurer Appointment and Termination	LIC 447-8
Endorsee Self Termination	LIC 411-8B
Fingerprint Impressions - Live Scan Service Request	LIC 442-39A
Individual Application for Insurance License (Resident & Non-Resident) Fast Licensing Application Service is Here (FLASH) (This service is available for most but not all license types)	LIC 441-9
Individual Application for Insurance License - Short Form	LIC 441-17
Live Scan Service Request	LIC 442-39A
Name Approval Request Name Approval Request Online Services (Available for new Business Entity applicants only)	LIC 447-42A
Parties Interested in the Pre-licensing & Continuing Education Program Provider Summary Notice	Provider Summary Notice
Portable Electronics Insurance Agent - Notice of Appointment	LIC PE 1
Portable Electronics Insurance Agent - Authorized Locations	LIC PE 2
Prelicensing/Continuing Education Program Course Approval Application	LIC 446-3
Prelicensing/Continuing Education Program Course Attendance Record and Verification Form	LIC 446-5
Prelicensing/Continuing Education Program Instructor Qualification Form	LIC 446-4
Prelicensing/Continuing Education Program Out-of-State Provider Jurisdiction Agreement	LIC 446-40
Prelicensing/Continuing Education Program Provider Certification/Renewal Application	LIC 446-2
Prelicensing/Continuing Education Program Stipulation to Maintain Records Outside of California	LIC 446-32
Prelicensing Education Requirements	LIC 446-8
Provider Roster Education Provider Online Programs	LIC 446-13
Reinsurance Intermediary Broker/Mgr./Individual Application	LIC 441-14
Reinsurance Intermediary Broker/Manager/Organization Application	LIC 441-15
Renew Individual License Application Free Application Online Renewal Service (FLRS) (This service is available for most but not all license types)	LIC 448-29A
Renew Business Entity License Application Free Application Online Renewal Service (FLRS) (This service is available for most but not all license types)	LIC 448-29B
Renew Individual Insurance Adjuster and Public Insurance Adjuster application	LIC 448-29C
Renew Business Entity Insurance Adjuster and Public Insurance Adjuster application	LIC 448-29D
Renew Title Marketing Representative application Free Application Online Renewal Service (FLRS) (This service is available for most but not all license types)	Late Renewal Only LIC 448-29E
Rental Car Agency - Annual Certification	LIC RCA 2
Rental Car Agency - Authorized Endorsees	LIC RCA 5
Rental Car Agency - Initial Certification	LIC RCA 1
Rental Car Agency - Rental Car Agent Notice of Appointment	LIC RCA 3
Rental Car Agency - Outline of Required Training Elements	LIC RCA 4
Request for Certificate of License Status Print your own Certificate of License Status	LIC 780
Self-Service Storage Facility - Authorized Endorsees	LIC SSA 1
Self-Service Storage - Notice of Appointment	LIC SSA 2
Self-Service Storage Facility - Required Training Elements	LIC SSA 3
Solicitor Self Termination	LIC 417-32
Surplus Line and/or Special Lines' Surplus Line Endorsement Authorization	LIC-050
Title 10 Regulations	§§ 2050-2698.86

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If you have any questions about the license information you retrieved, please see the most commonly asked questions in our License Questions and Answers section. If you need further assistance, please call CDI's Producer Licensing Bureau at (800) 967-9331 or send an e-mail to the Producer Licensing Bureau. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the Department.