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AGENTS & BROKERS: Short Form

Licensees
New Individual Short Application For Insurance License is Available
[For Current Licensees Only]

The California Department of Insurance's (CDI) Producer Licensing Bureau is continually looking for ways to make your application process faster and easier. In that regard, we have created an Individual Short Form LIC 441-17* application. Current licensees who would like to add another license type may use the California Department of Insurance's new Short Form LIC 441-17*. 

Short Form - Ease of Use

The Short Form (LIC 441-17*) has only two pages for the applicant to complete in order to add another license type to his or her license. A life agent, for example, would complete only a two-page application (Short Form LIC 441-17*) to add a property and/or casualty license type to his or her license instead of having to complete the six page Individual Application form LIC 441-9*). It is no longer necessary for the licensee to provide the background information that Individual Application form (LIC 441-9*) requires each time the licensee adds a new license type to his or her license. That information is already in the CDI's licensing database. The Short Form's (LIC 441-17*) two-page application is convenient for licensees and, saves time and paper work. 

License Types

This new two-page Short Form (LIC 441-17*) provides an easier application process for current licensees to add the following license types:

  • Life-Only Agent
  • Accident and Health Agent
  • Limited Lines Automobile Insurance Agent
  • Property Broker-Agent
  • Casualty Broker-Agent
  • Personal Lines Broker-Agent
  • Surplus Lines Broker
  • Special Lines' Surplus Line Broker.

Questions

If you have any questions about this form or 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 (916) 322-3555. The Call Center is available Monday through Friday, 7:00 a.m. to 5:00 p.m., excluding State Holidays.  

You may also send an e-mail to Producer Licensing Bureau. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the CDI.

*These forms are in PDF format. To view these forms, your browser 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.

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