Interim Public Insurance Adjuster
Application for Individual Adjuster license, form LIC 041-A.
Bond of Public Insurance Adjuster, form LIC 94A.
Public Insurance Adjuster Authorization Application, form LIC 0100A.
Request For Live Scan Service, form LIC 442-39A.
Authorizing Act: Section 15016 of the California Insurance Code reads, in part:
An Interim Public Insurance Adjuster licensee is a person employed by a Public Insurance Adjuster for the purpose of training.
- Minimum Age: 18 years
- Residency: California residency is required
- Entity: Individual
- Prelicensing Experience/Education: Not required
- Continuing Education: Not required
- Application: Application for Individual Adjuster license, form LIC 041-A.
- Bond: A Bond of Public Insurance Adjuster, form LIC 94A, in the penal sum of $20,000 executed in California, by a California admitted surety; completed in the name of the applicant.
- Employer Authorization: Public Insurance Adjuster Authorization Application, form LIC 0100A completed by the Public Insurance Adjuster who will employ the applicant for training purposes.
- Fingerprint Impressions: Fingerprint impressions are required for unlicensed applicants.
- Additional Documents: The Insurance Commissioner may require such other documents as will aid in determining whether the applicant meets the qualifications for a license.
- Examination: Not required
- License Filing: $218 (effective March 1, 2015 this fee will be $240), the license expires one year from date issued unless otherwise canceled.
- Application: $56 (effective March 1, 2015 this fee will be $62).
- Employer Authorization: $56 (effective March 1, 2015 this fee will be $62), the employer authorization is canceled one year from the date the license is issued unless otherwise canceled.
- Fingerprint Processing: Review Fingerprint Processing link for fees.
- Federal law (Title 18 United States Code Section 1033) prohibits anyone who has been convicted of a felony involving dishonesty or a breach of trust from conducting the business of insurance unless they have obtained the written consent of the Insurance Commissioner. It is a violation of this statute to conduct business of insurance without the Commissioners written consent. If you have been convicted of a felony involving dishonesty or a breach of trust then you must attach a copy of this consent. If you have not obtained this written consent you must do so by filing a 1033 Short Form Application for Written Consent prior to filing your application.
- If the interim applicant/licensee ceases to be employed as such, an Public Insurance Adjuster Authorization Application, form LIC 0100A, completed by the employer to show termination of such employment, is required to be filed with the Department. An interim licensee may not act as such unless an active authorization is on file.
- An interim license is not renewable.
- After experience qualifications have been met, an interim licensee may file for a Public Insurance Adjuster license. Refer to the Public Insurance Adjuster's licensing requirements.
- To obtain insurance licensing forms by mail, send an e-mail request to: Producer Licensing Bureau.
- To obtain Adjuster licensing information, you may phone the Producer Licensing Bureau's Adjuster unit at (916) 492-3085.
All fees mailed to the Department must be addressed to:
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 or an examination taken.
LIC 670C (Rev. 04/2013)