Application Procedures Individual Non-Residents

Step 1 - Application

Submit a business entity application online through Sircon or the National Insurance Producer Registry (NIPR) or a Business Entity Application Public Insurance Adjuster license, LIC CDI-181.

Step 2 - Public Insurance Adjuster Authorization Application

Submit a Public Insurance Adjuster Authorization Application, LIC 0100A, for each person who is employed by a licensed public adjuster. All persons acting as a public insurance adjuster must be licensed as either a public insurance adjuster or an apprentice public insurance adjuster. Please note this form must be signed by both the employee and the employer prior to being uploaded into the Sircon application.

The following are the required items to be submitted with the public adjuster license application:

Step 2(a) - Bond

Complete a Bond of Public Insurance Adjuster, LIC 94A, in the penal sum of $20,000, by a California admitted surety, in the name of the applicant and signed by the applicant authorizing the person to act as a public insurance adjuster.

This bond requires the following items to be included/uploaded into the Sircon application: 

• The completed LIC 94A
• The Power of Attorney (if the bond was not executed by an officer of the insurer)
• The Jurat (if the Seal of Surety Corporation was not included in the Power of Attorney)

Step 2(b) – Branch Office Certificate

If the applicant intends to conduct business from any location in California other than the principal place of business, a Branch Office Certificate must be obtained by submitting an Application for Branch Office Certificate, LIC 31A-13, which includes a $39 filing fee.
 

Step 2(c) - Contract

Pursuant to California Insurance Code section 15027, no licensee shall, directly or indirectly, act within this state as a public insurance adjuster without having first entered into a business contract, in writing, on a form approved by the insurance commissioner and executed in duplicate by the public adjuster and the insured or a duly authorized representative. One original contract shall be kept on file by the licensee, available at all times for inspection, without notice, by the commissioner or his or her duly authorized representative, and one original contract shall be given to the insured.

The Department is providing a sample contract for Public Insurance Adjusters to follow when developing their business contract. Please submit a new or revised business contract to the following address: Sac.Adjusters@insurance.ca.gov

Although the applicant or licensee is not required to use the sample contract, following the sample contract should expedite the approval process. However, all contract forms must meet the requirements stated in California Insurance Code section 15027 and must be approved by the Department’s Legal Division prior to use.

Note: Pursuant to California Insurance Code section 15027(v) prior to signing of the contract, the licensee shall provide the insured with a separate printed disclosure document that bears the name and license number of the licensee.

Step 3 – Fees

• License two-year filing fee: $264
• Branch Office Certificate: $39

No portion of the filing fees shall be refunded, whether or not the application is acted upon, or the examination is taken. (California Insurance Code section 1751.5)

Additional Documents:

The Insurance Commissioner may require such other documents as will aid in determining whether the applicant meets the qualifications for a license.

Contact

For specific questions regarding this license, please send an e-mail to the Sac.Adjusters@insurance.ca.gov or call the Department’s Licensing Hotline at (800) 967-9331 and select the Adjuster extension 6. Please be sure to provide your name, telephone number, license number and e-mail address in all correspondence with the Department.

Contact

For specific questions regarding this license type, please

• E-mail the Licensing Processing Section at Licensing Services Division e-Mail 
• Call the Licensing Hotline at (800) 967-9331.