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Producer Licensing Forms in Alphabetical Order

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


Return to Producer Licensing Bureau Forms Main Page

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.

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