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AGENTS & BROKERS: 1033 APPLICATION FOR WRITTEN CONSENT PURSUANT TO 18 U.S.C., SECTION 1033

Filing Requirements

Authorizing Act: 18 U.S.C., Sections 1033; California Code of Regulations, Title 10, Chapter 5, Subchapter 1, Article 4.5

Any and all Prohibited Persons who are currently participating in the business of insurance, or who intend to participate in the business of insurance, must receive the written consent of the Insurance Commissioner before participating or continuing to participate in the business of insurance.[CCR § 2175.3]

Any person who meets the criteria of a "Prohibited Person" and is applying for an insurance producer license must first receive the written consent of the Insurance Commissioner before participating in the business of insurance.

"Prohibited Person" means any person who has been convicted of a felony involving dishonesty or breach of trust, or who has been convicted of any violation of 18 U.S.C. § 1033 (the "Act"), who wishes to engage or participate in the business of insurance in this State. A "Prohibited Person" may be an officer, director, employee, agent, solicitor, broker, consultant, third-party administrator, managing general agent, or subcontractor of a resident insurance agency or insurance company domiciled in California.[CCR § 2175.2(m)]

"Conviction" means a finding of guilty or a plea of guilty, nolo contendere or no contest in a criminal court of the United States of America or in any state, commonwealth or possession. Completion of deferred adjudication and conditional discharges are not convictions. [CCR § 2175.2(f)]

"Felony" means:

  1. Any Federal crime for which the maximum authorized punishment exceeds one year of imprisonment;
  2. Any crime for which the maximum authorized punishment exceeds one year incarceration; or
  3. Any crime in any other state, commonwealth, territory or possession that is identified as a felony in that state, commonwealth, territory or possession, or if not identified as a felony in said other jurisdiction, any offense for which the maximum authorized punishment exceeds one year incarceration.
  4. Any conviction of a felony crime of dishonesty, breach of trust or violation of 18 U.S.C. § 1033 which has been set aside pursuant to California Penal Code section 1203.4.[CCR § 2175.2(h)]

"Dishonesty" means a crime which includes, but is not limited to, any offense involving perjury, bribery, forgery, counterfeiting, false or misleading oral or written statements, deception, fraud, schemes or artifices to deceive or defraud, material misrepresentations and the failure to disclose material facts.[CCR § 2175.2(g)] 

"Breach of Trust" means crimes including, but not limited to, any offense involving misuse, misapplication or misappropriation of (1) anything of value held as a fiduciary or (2) anything of value of a public private or charitable entity.[CCR § 2175.2(c)]

The Prohibited Person must file an Application for Written Consent with the CDI as set forth in [CCR § 2175.6*]. If you meet the definition of a "Prohibited Person" you must submit:

  • A completed 1033 Short Form Application for Written Consent. All 1033 Consent Applications must be completed in full & typewritten. Any application that is not typewritten will be returned to the applicant. 
    Note:
    The NAIC Short form application does not need to be notarized by a notary of the public for 1033 applicants seeking written consent from the CDI. Application forms may also be obtained by contacting the Licensing Background Bureau at (916) 492-3650.
  • A non-refundable processing fee in the amount of $145 payable to the California Department of Insurance.
  • Two 2" x 2" recent passport photographs attached to the upper right hand corner of the Application for Consent.
  • Certified copies of all court documents setting forth the initial conviction and any subsequent disposition, together with any other relevant documents or information that the Prohibited Person would like to have considered. All such documents must be submitted within 30 days of the receipt by applicant of a notice of deficiency from the CDI.

Mail the above items to:

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


Additional Requirements

•   All 1033 Applicants for Written Consent also need to be fingerprinted.

There are three options to to obtain fingerprint impressions:

1) At a California Department of Justice authorized Live Scan Fingerprinting vendor.

  • Review the Live Scan Fingerprinting Vendor list to choose the fingerprint vendor closest to you. 
  • Take your completed Live Scan Request form to the live scan vendor.
  • Obtain fingerprint impressions.
  • Retain a copy of the Live Scan Request Form 442-39A for your records. Give the copy of the form to the live scan service vendor who will provide you with the Automated Transaction Identifier (ATI) number that is assigned to your fingerprint impressions. If your fingerprint impressions are rejected, the ATI number will allow for you to have your fingerprint impressions redone at no charge.

2) At the CDI's examination site.

  • The fingerprint impressions will be taken by the CDI's Contracted Fingerprint Vendor, Accurate Biometrics a live scan fingerprinting service authorized by the California Department of Justice (DOJ). You must schedule an appointment with Accurate Biometrics by calling (866) 361-9944 before coming to the CDI's examination site to have your fingerprint impressions processed.

3) At a location outside of California for non-residents to obtain fingerprint impressions completed using fingerprint cards.

  • These fingerprint impressions must be taken by a law enforcement agency (police department, sheriff's office, etc.) on the standard FBI fingerprint card, Form #FD-258. The fingerprint card is available either from the law enforcement agency that you contact to obtain the fingerprints or by contacting the Licensing Background Bureau at (916) 492-3650.
  • To ensure that your fingerprint impressions are properly recorded, you must enter the number "A0042" in the space designated for the "ORI" number; and enter "1033/CIU" in the space designated for "OCA" number on the fingerprint card. Complete the identifying sections of the fingerprint card including your name and social security number.  The fingerprint card and the check must be mailed directly to the vendor.
  • Take your completed Live Scan Request form to the live scan vendor.
  • Complete the fingerprint impressions.
  • One set of fingerprint impressions on fingerprint card form FD-258, including a fingerprint processing fee check made payable to vendor.
  • Retain a copy of the Live Scan Request Form 442-39A for your records. Give the copy of the form to the live scan service vendor who will provide you with the Automated Transaction Identifier (ATI) number that is assigned to your fingerprint impressions. If your fingerprint impressions are rejected, the ATI number will allow for you to have your fingerprint impressions redone at no charge.
  • The fingerprint cards will need to be mailed to the CDI's contracted vendor, Accurate Biometrics, for processing. You can contact Accurate Biometrics by calling (866) 361-9944. 
    Accurate Biometrics
    8680 Greenback Lane, Suite 200
    Orangevale, CA  95662
  • California Non-Resident Insurance Producer Fingerprint Requirements

Fees:

1033 Application processing fee: $145 made payable to California Department of Insurance.

Fingerprint Processing fee: FBI processing fee of $17, DOJ processing fee of $32, and an additional "rolling fee" charged by the DOJ authorized vendor. The additional "rolling fee" will vary depending on the vendor and is noted on DOJ's listing of authorized Live Scan Fingerprint vendors.



Consideration of Application for Written Consent

Factors to be considered by the Commissioner in granting or denying an Application for Written Requests for Consent will include, but are not limited to the following:

  • The nature and severity of the crime.
  • The length of time since the conviction
  • The injury and/or loss caused by the Prohibited Person. Whether the conviction is related to the business of insurance.
  • Whether the Prohibited Person received a pardon from the sovereign that convicted him.
  • Whether the Prohibited Person completed parole or probation.
  • Whether a breach of trust, dishonesty or a violation of the Act was involved.
  • Strength of character reference letters.
  • The person's business and personal record before and after the conviction.
  • Whether and to what extent the person has made material false statements in an application, renewal or in other documents filed with the Commissioner.
  • Whether and to what extent the person has made material false statements in applications or other documents filed with other State or federal agencies.
  • Whether the Prohibited Person's conviction was expunged.
  • Whether the conviction was received in a foreign country.             
    CCR § 2175.7*

The following criteria shall apply in considering the application for Written Consent:

  • The Commissioner shall, within twenty-one (21) calendar days of receipt of the application, inform the applicant, in writing, that the application is deficient and what specific information is required for completion.
  • Any deficient application for Written Consent that is not resubmitted to the CDI within 30 days of the applicant's receipt of a Notice of deficiency on the application, shall be deemed withdrawn.
  • The Commissioner shall, within thirty (30) calendar days of receipt of a complete application, reach a decision whether to grant or deny a request for consent, and shall notify the applicant of the decision.
  • The periods set forth above shall be tolled in the event the application requires legal action by the Commissioner.
  • The CDI's minimum, median, and maximum times for processing an application for Written Consent, from the receipt of the initial completed application to the final license decision, CCR § 2178*, (excluding applications that require legal action by the Commissioner), are as follows:

(1) thirty (30) calendar days (median time)

(2) fourteen (14) calendar days (minimum time)

(3) one (1) calendar year (maximum)


Termination of Written Consent

Failure of the Prohibited Person to comply with all the terms and conditions will result in the termination of the Written Consent and if applicable, summary revocation of the license to transact the business of insurance,[CCR § 2176]. Terms and conditions include, but are not limited to the following:

  • Subsequent misdemeanor or felony charge involving dishonesty, breach of trust or a violation of 18 U.S.C., § 1033.

  • Failure to notify the CDI of any misdemeanor or felony charge involving dishonesty, breach of trust or violation of 18 U.S.C., § 1033.

  • The filing of an Administrative sanction against the prohibited person. 

  • Failure to comply with any provision of these regulations.

  • Failure to notify the CDI upon the filing of any action by a Regulator.

  • Failure to amend an application for Written Consent upon a change of job duties.

  • Failure to notify employer of status as a Prohibited Person.

  • Making materially false or misleading statements, or failure to disclose material information on the application for Written Consent.

*Important note: Sections 2175.6 through 2175.9 and 2178 are under review by the Office of Administration Law and, therefore, are pending approval.



If you need further assistance, please call CDI's Licensing Background Bureau at (916) 492-3650. Please be sure to include your name, telephone number, license number (if applicable), and reference the 1033 Application filing requirement.

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