Submitting a Background Change

California Insurance Code section 1729.2 requires an applicant or licensee to notify the commissioner in writing within 30 days of the date the applicant or licensee learns of a change in background information. The law further requires that a business entity licensee, upon learning of a change in background information pertaining to any unlicensed person listed on its business entity license or application thereof, shall notify the commissioner of that change. The changes subject to this requirement include changes pertaining to any unlicensed officer, director, partner, member, or controlling person, or any other natural person named under the business entity license or application. Licensees who are named as endorsees under a business entity license must also report any change in background information, as defined in the code, to any officer, director, partner, or controlling person of the business entity license.

Background Information Change Disclosure Form and Instructions

Applicants and licensees must complete the Background Information Disclosure form LIC 2557B along supporting documents electronically through SimpliGov. All submitted documents should be in a PDF format, clear of any markings.

Acceptable documents:

• For criminal convictions, a signed statement detailing the incident/s that occurred, certified court documents, evidence of rehabilitation (if acquired), and arrest report/incident narrative are required.
• For disciplinary actions, a signed statement detailing the incident/s that occurred, and copies of the final orders are required.

For questions regarding background change disclosures, please email the Licensing Background Section at LICbackgrounds@insurance.ca.gov.