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CA Department of Insurance

Checklist for Required Items

Materials

  1. Submit paper application - Business Entity - Form LIC 441-11
  2. Include Application Filing Fee - $4,128
  3. Submit Notice of Agent appointment - Limited Lines Travel Insurance Agent Form LIC TA 1
  4. Submit completed Initial Certification of Authorized Travel Retailers - Limited Lines Travel Insurance Agent, Form LIC TA 2
  5. Submit training material stated in "Outline of Required Training Elements, Form LIC TA 3

Where to file:

California Department of Insurance
P.O. Box 1139
Sacramento, CA 95812-1139

All filing fees submitted are not refundable, whether or not the application is acted upon.

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